Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, eastern Sudan

Prevalence and Factors Associated with Adherence to Iron-Folic Acid Supplementation Among Pregnant Women in Eastern Sudan: A Cross-Sectional Study

Purpose

The present study was conducted to determine the prevalence and factors associated with adherence to iron-folic acid supplementation (IFAS) among pregnant women in eastern Sudan.

Methods

A cross-sectional survey was conducted among pregnant women who obtained antenatal care (ANC) at Gadarif Maternal Hospital in eastern Sudan between May 1 and August 31, 2023. Face-to-face interview questionnaires were used to gather sociodemographic, obstetric, and clinical data (age, parity, education, residence, and previous medical diseases). Knowledge of anemia and IFAS was assessed. Multivariate analysis was performed to adjust for confounders.

Results

A total of 568 pregnant women were enrolled in the present study. Among them, 449 (79.0%) adhered to the IFAS. The multivariate analysis showed that the adjusted odds ratio (AOR) of IFAS adherence increased with ANC visits > 4 (AOR = 1.68, 95.0% CI = 1.01-2.77) and knowledge of anemia (AOR = 2.06, 95.0% CI = 1.437-3.276). In the univariate analysis, maternal occupation and knowledge of IFAS adherence were the only factors associated with IFAS adherence. Maternal age, parity, gestational age, education, residence, occupation, medical insurance, medical disease, and husband's occupation were not associated with IFAS. Forgetfulness (71.0%), frustration from taking many drugs (54.6%), and unpleasant tests of the supplement (50.7%) were the main reasons for not taking the IFAS.

Conclusion

About four out of five pregnant women adhered to the IFAS, indicating a good level of adherence, especially among women who attended more than four ANC visits and those with good knowledge of anemia. More attention is needed to encourage ANC to increase adherence to IFAS.

Association Between Hemoglobin Level, Anemia, and Hypertension Among Adults in Northern Sudan: A Community-Based Cross-Sectional Study

Background

Hypertension and anemia are major health problems globally. However, data regarding the association between hypertension and hemoglobin/anemia among adults are few and controversial. Therefore, the current study aimed to investigate the associations between hemoglobin/anemia and hypertension among Sudanese adults.

Methods

A community-based cross-sectional study was conducted in Northern Sudan from September to December 2022. The participants' sociodemographic characteristics were assessed using a questionnaire. Standardized procedures measured participants' weight, height, body mass index (BMI), hemoglobin, and hypertension. Multivariate regression analysis was performed to determine the association between anemia and hypertension.

Results

Three hundred eighty-four adults were enrolled; 195 (50.8%) and 189 (49.2%) were males and females, respectively. The median interquartile age of the enrolled adults of age, BMI, and hemoglobin level was 45.0 (33.0‒55.8) years, 26.6 (22.6‒30.6) kg/m2, and 13.4 (12.4‒14.4) g/dl, respectively. Of 384 adults, 216 (56.3%) had hypertension, and 148 (38.5%) were newly diagnosed hypertensive. Eighty-six adults (22.4%) had anemia. In univariate analysis, while increasing age, being female, being unmarried, having a positive family history of hypertension, and increasing BMI were positively associated with hypertension, anemia was inversely associated with hypertension. Education, occupation, cigarette smoking, and alcohol consumption were not associated with hypertension. In multivariate analysis, age (adjusted odd ratio [AOR] = 1.05, 95% confidence interval [CI] = 1.03‒1.07), BMI (AOR= 1.07, 95% CI = 1.03‒1.12) were inversely associated with hypertension, being female (AOR = 2.92, 95% CI = 1.43‒5.94), positive family history of hypertension (AOR= 1.73, 95% CI = 1.09‒2.75), and hemoglobin level (AOR= 1.34, 95% CI = 1.12‒1.61) were associated with hypertension. Anemia (AOR = 0.58, 95% CI = 0.34‒0.99) was inversely associated with hypertension.

Conclusion

Both anemia and hypertension are major public health problems in Northern Sudan. Anemia is associated with hypertension. Further research is needed to explore the complex association between hemoglobin/anemia and hypertension.

Use of Photoacoustic Imaging to Study the Effects of Anemia on Placental Oxygen Saturation in Normoxic and Hypoxic Conditions

We aimed to evaluate fetal and placental oxygen saturation (sO2) in anemic and non-anemic pregnant rats throughout gestation using photoacoustic imaging (PAI). Female Sprague-Dawley rats were fed an iron-restricted or iron-replete diet before and during pregnancy. On gestational days 13, 18, and 21, PAI was coupled with high resolution ultrasound to measure oxygenation of the fetus, whole placenta, mesometrial triangle, as well as the maternal and fetal faces of the placenta. PAI was performed in 3D, which allowed sO2 to be measured within an entire region, as well as in 2D, which enabled sO2 measurements in response to a hypoxic event in real time. Both 3D and 2D PAI were performed at varying levels of FiO2 (fraction of inspired oxygen). Iron restriction caused anemia in dams and fetuses, a reduction in fetal body weight, and an increase in placental weight, but overall had minimal effects on sO2. Reductions in FiO2 caused corresponding reductions in sO2 which correlated to the severity of the hypoxic challenge. Regional differences in sO2 were evident within the placenta and between the placenta and fetus. In conclusion, PAI enables non-invasive measurement of sO2 both rapidly and with a high degree of sensitivity. The lack of overt changes in sO2 levels between control and anemic fetuses may suggest reduced oxygen extraction and utilization in the latter group, which could be attributed to compensatory changes in growth and developmental trajectories.

Retrospective Study Comparing Treatment Outcomes in Obstetric Patients With Iron Deficiency Anemia Treated With and Without Intravenous Ferric Carboxymaltose

Introduction Iron deficiency anemia is associated with an increased risk of adverse maternal and perinatal outcomes. Intravenous iron preparation containing ferric carboxymaltose has been shown to be a safe and effective way of increasing hemoglobin (Hb) and mean corpuscular volume (MCV) levels and reducing the need for blood transfusion. In our center, it used to be given as an inpatient procedure because of the risks of potential drug reactions. In 2021, we initiated the administration of intravenous ferric carboxymaltose as an outpatient procedure. We compared the outcomes of patients between 2021 and 2023 after the initiation of outpatient administration of intravenous ferric carboxymaltose in 127 obstetric patients with iron deficiency anemia in the second and third trimesters. Methods In this study conducted in a large maternity unit in Singapore between 2021 to 2023, we compared the changes in maternal hematological parameters among obstetric patients with iron deficiency anemia presenting to the day care unit in the second or third trimester with a Hb level of <8 g/dl treated with a single dose of ferric carboxymaltose injection (Ferinject) against a control group who were referred for treatment but defaulted on and declined treatment. Results Ferric carboxymaltose significantly increased the Hb and MCV levels at delivery in obstetric patients with iron deficiency. The mean Hb at delivery was 10.8 g/dL in the case group compared to 8.8 g/dL in the control group. The percentage of patients with Hb ≥10.0 g/dL was 73.4% in the case group compared to 27.8% in the control group. The incidence of adverse side effects was low and mild (2/127; 1.6%). None of the patients received were hospitalized because of ferric carboxymaltose. Conclusion A single injection dose of ferric carboxymaltose as an outpatient antenatal procedure was easily administered and well tolerated. Obstetric patients with iron deficiency anemia who received intravenous ferric carboxymaltose had a significantly higher level of Hb than those who did not.

Maternal and Neonatal Outcomes of Iron Deficiency Anemia: A Retrospective Cohort Study

INTRODUCTION

Understanding the outcomes of anemia in pregnancy is critical. Since no study has been conducted regarding the maternal and neonatal outcomes of iron-deficiency anemia in Hormozgan province of Iran, this study aims to assess the maternal and neonatal outcomes of iron-deficiency anemia in women who gave birth in Hormozgan province from January 2020 to January 2022.

METHODS

 We retrospectively assessed all singleton pregnant women who gave birth at a tertiary hospital in Bandar Abbas, Hormozgan province, Iran, for two years. We divided all women into iron-deficiency anemic and non-iron-deficiency anemic women. Iron-deficiency anemia was defined as hemoglobin less than 10.5 mg/dl at the time of admission without any other hemoglobinopathy, such as sickle cell anemia or thalassemia. Using electronic patient records, data were extracted from the Iranian Maternal and Neonatal Network (IMaN Net), a valid national system. Since the information of birth under 24 weeks of gestation is not recorded in this system, we excluded all deliveries under 24 weeks of gestation. The outcome measures of the study were demographic factors (age, education, residency place, access to prenatal care, smoking), obstetrical factors (parity, labor induction, fetal presentation, mode of delivery), and maternal and neonatal outcomes (the incidence of preeclampsia, gestational diabetes, placenta abruption, postpartum hemorrhage, maternal need for blood transfusion, maternal need for intensive care unit, preterm birth, low birth weight, intrauterine growth retardation, birth asphyxia, stillbirth, and neonatal intensive care admission). Chi-square tests were used to compare differences between iron-deficiency anemic and non-iron-deficiency anemic women. Logistic regression models were used to assess the effect of iron-deficiency anemia on maternal and neonatal outcomes. The result was presented as odds ratio (OR) or adjusted odds ratio (aOR) after adjusting for covariates and a 95% confidence interval (CI).  Results: The incidence of iron-deficiency anemia was 2.97%. Education and residency were among the demographic factors that differed significantly between groups. Iron-deficiency anemia was more frequent in those with higher education and women who lived in rural areas. In terms of obstetrical factors, method of delivery was the only significantly different factor between groups. Iron-deficiency anemic mothers had substantially more instrumental deliveries than non-iron-deficiency anemic mothers (4.3% vs. 0.8%), while the incidence of cesarean section was lower. Based on logistic regression in terms of maternal and neonatal outcomes, iron-deficiency anemic women had a substantially higher risk of the need for maternal blood transfusion (aOR: 6.54, 95%CI: 4.72-8.15), postpartum hemorrhage (aOR: 1.54, 95%CI: 0.71-2.11), preterm birth (aOR: 0.98, 95%CI: 0.45-1.13), low birth weight (aOR: 1.04, 95%CI: 0.78-2.01), intrauterine growth retardation (aOR: 1.30, 95%CI: 0.99-2.10), and neonatal intensive care admission (aOR: 1.06, 95%CI: p.52-2.72), after adjusting for educational level, residency place, and method of delivery.

CONCLUSIONS

Despite the higher incidence of postpartum hemorrhage and maternal blood transfusion, we found no increase in maternal intensive care unit admission risk. Regarding neonatal outcomes, iron-deficiency anemia was linked to preterm birth, low birth weight, intrauterine growth retardation, and neonatal intensive care admission.

Predictors of maternal and fetal outcome in severely anemic pregnant mothers: A sequential mixed methods study

Introduction

Severe anemia in pregnancy increases maternal and neonatal morbidity and mortality in the antenatal period.

Objective

To find out the maternal and fetal outcomes in severely anemic pregnant women and explore the reason for the persistence of severe anemia in pregnant women.

Materials and Methods

Sequential explanatory mixed method study (Quan-Qual) was conducted in the Government Women and Children Hospital for a period of 1 and half years. Most of the people were from rural backgrounds and belonging to low socioeconomic status have been registered. Quantitative data were collected from 125 severe anemic cases; a consecutive sampling technique was applied. In-depth interviews were conducted among purposively selected severe anemic patients (n = 15) who were vocal and willing to explore the reason for the persistence of anemia. The interviews were conducted till the point of saturation. Ethical principles were adhered throughout the study. Quantitative data were anlyzed using SPSS software. Manual content analysis was done for qualitative data.

Results

Among 125 severe anemic patients, 12.8% patients had preterm labour, about 23.2% had inadequate lactation, and 13.6% had a puerperal febrile illness. It was found 41.6% of neonates had respiratory distress and 33.6% had the refusal of feeds. When compared to vaginal delivery, women undergoing cesarean section have 3.2 times (95% confidence interval 1.39-7.32) higher odds of developing maternal complications. Nagelkerke's R2 value for the model was 11.1%. Five broad categories namely Family centric nature, Lack of awareness, Pill burden, Food Fads, and Myths related to iron intake emerged from the study.

Conclusion

Complications can occur in mothers and neonates if anemia is not corrected in early trimester.

Association between maternal anemia and stunting in infants and children aged 0-60 months: A systematic literature review

OBJECTIVES

Maternal anemia is a worldwide health issue and a common pregnancy complication. It leads to consequences including infant mortality, low birth weight, preterm birth, unrecoverable or partially reversible neurobehavioral and cognitive deficits, and short birth length. However, the relationship between maternal anemia and stunting in children is not well defined. This systematic literature review sought to determine whether maternal anemia was associated with height or length and stunting conditions in infants and children ages 0-60 mo in cohort, case-control, and cross-sectional studies carried out in several countries.

METHODS

A systematic review was performed on articles published from 2014-2021 related to maternal anemia and stunting. The electronic databases used were ScienceDirect, PubMed, Scopus, ProQuest, Google Search, and AJOG (American Journal of Obstetrics and Gynecology). The literature search was performed up to December 7, 2021.

RESULTS

Twelve studies were included. Nine studies examined the correlation between maternal anemia and length or weight in children. Seven of the nine studies showed an association between maternal anemia and stunting in children; the others showed an association between maternal anemia and birth length. Three studies found no association between maternal anemia and stunting in children under age 5 y.

CONCLUSIONS

The current review emphasizes that stunting in children may be associated with maternal anemia, specifically in developing countries. This implies that it is crucial to prevent anemia in adolescent girls and women before and during pregnancy as a part of programs to eliminate stunting in children.

Space-time cluster analysis of anemia in pregnant women in the province of Khyber Pakhtunkhwa, Pakistan (2014-2020)

Anaemia is a common public-health problem affecting about two-thirds of pregnant women in developing countries. Spacetime cluster analysis of anemia cases is important for publichealth policymakers to design evidence-based intervention strategies. This study discovered the potential space-time clusters of anemia in pregnant women in Khyber Pakhtunkhwa Province, Pakistan, from 2014 to 2020 using space-time scan statistic (SatScan). The results show that the most likely cluster of anemia was seen in the rural areas in the eastern part of the province covering five districts from 2017 to 2019. However, three secondary clusters in the West and one in the North were still active, signifying important targets of interest for public-health interventions. The potential anemia clusters in the province's rural areas might be associated with the lack of nutritional education in women and lack of access to sufficient diet due to financial constraints.

The Interplay of Hypertension and Anemia on Pregnancy Outcomes

Background Anemia and pregnancy-induced hypertension (PIH) are two significant high-risk conditions that can have a profound impact on maternal health during pregnancy. The scarcity of studies investigating the potential links and interactions between these two conditions adds to the gap in our understanding of their combined impact on pregnant women. This study aimed to assess the impact of PIH in conjunction with anemia and without anemia on pregnancy outcomes. Methods A prospective study was conducted among 150 primi pregnant women (third trimester of pregnancy) from a secondary-care hospital (Government General Headquarters Hospital, Cuddalore) in Tamil Nadu, India. The study population was selected using a purposive sampling technique. Data were collected using a structured questionnaire to assess sociodemographic characteristics, dietary patterns, and outcomes of pregnancy. Clinical parameters such as blood pressure were measured using a sphygmomanometer, and hemoglobin and urine tests for protein were obtained from the patient's medical records. Results The result showed that out of 150 primi pregnant women, 73 (49%) had PIH and 77 (51%) experienced both PIH and anemia. On comparing the outcomes, pregnant women with PIH accompanied by anemia exhibited developing preeclampsia (p<0.001), encountered maternal complications (p=0.034), delivered preterm babies (p=0.03), and gave birth to low-birth-weight babies (p<0.001), and their newborns admitted to the NICU (p=0.02). Additionally, pregnant women with both PIH and anemia demonstrated significantly higher levels of systolic blood pressure after delivery (p=0.009). Conclusion  The study calls for the immediate attention of healthcare providers for vigilant monitoring and addressing anemia in conjunction with PIH to improve maternal and neonatal outcomes.

Intravenous infusions of ferumoxytol compared to oral ferrous sulfate for the treatment of anemia in pregnancy: a randomized controlled trial

BACKGROUND

Iron-deficiency anemia in pregnancy is highly prevalent and presents significant risk to patients. Initial treatment is often with oral medication. We hypothesized that intravenous ferumoxytol would result in superior treatment of anemia as compared to oral ferrous sulfate.

OBJECTIVE

This study aimed to investigate whether 2 infusions of intravenous ferumoxytol are superior to the use of twice-daily oral ferrous sulfate for the treatment of iron-deficiency anemia in pregnancy.

STUDY DESIGN

A randomized controlled trial was performed in which participants with anemic (hemoglobin <11 g/dL and hematocrit <33%) were allocated to receive either 2 infusions of 510 mg of intravenous ferumoxytol approximately 7 days apart, or 325 mg oral ferrous sulfate twice daily from enrollment to the end of their pregnancy. Participants were randomized in a 1:1 ratio to each treatment. Our primary outcome was the change in maternal hemoglobin. Secondary outcomes included maternal iron indices, maternal safety, and maternal tolerability.

RESULTS

There were 124 participants (N=62 per group). In the intravenous iron group, the mean change in hemoglobin was 1.86 g/dL (95% confidence interval, 1.57 g/dL-2.14 g/dL) and in the oral group was 0.79 g/dL (95% confidence interval, 0.42 g/dL-1.17 g/dL) (P<.0001). The median change in ferritin between groups was 64.5 (range, 31-364) vs 8 (range, -436 to +167) (P=.0001). The median change in iron between groups was also statistically significant with 47.5 ug/dL (range, -133 ug/dL to +664 ug/dL) in the intravenous group vs 8.5 ug/dL (range, -313 ug/dL to +437 ug/dL) in the oral iron group (P=.001).

CONCLUSION

Intravenous ferumoxytol was well tolerated, and it was associated with statistically significant increases in maternal hemoglobin, hematocrit, iron, and ferritin compared to oral ferrous sulfate.

Maternal low and high hemoglobin concentrations and associations with adverse maternal and infant health outcomes: an updated global systematic review and meta-analysis

BACKGROUND

Growing evidence suggests low and high maternal hemoglobin (Hb) concentrations may have adverse consequences for maternal and child health. There remain questions on specific Hb thresholds to define anemia and high Hb as well as how cutoffs may vary by anemia etiology and timing of assessment.

METHODS

We conducted an updated systematic review (using PubMed and Cochrane Review) on low (< 110 g/L) and high (≥ 130 g/L) maternal Hb concentrations and associations with a range of maternal and infant health outcomes. We examined associations by timing of Hb assessment (preconception; first, second, and third trimesters, as well as at any time point in pregnancy), varying cutoffs used for defining low and high hemoglobin concentrations and performed stratified analyses by iron-deficiency anemia. We conducted meta-analyses to obtain odds ratios (OR) and 95% confidence intervals.

RESULTS

The updated systematic review included 148 studies. Low maternal Hb at any time point in pregnancy was associated with: low birthweight, LBW (OR (95% CI) 1.28 (1.22-1.35)), very low birthweight, VLBW (2.15 (1.47-3.13)), preterm birth, PTB (1.35 (1.29-1.42)), small-for-gestational age, SGA (1.11 (1.02-1.19)), stillbirth 1.43 (1.24-1.65)), perinatal mortality (1.75 (1.28-2.39)), neonatal mortality (1.25 (1.16-1.34), postpartum hemorrhage (1.69 (1.45-1.97)), transfusion (3.68 (2.58-5.26)), pre-eclampsia (1.57 (1.23-2.01)), and prenatal depression (1.44 (1.24-1.68)). For maternal mortality, the OR was higher for Hb < 90 (4.83 (2.17-10.74)) than for Hb < 100 (2.87 (1.08-7.67)). High maternal Hb was associated with: VLBW (1.35 (1.16-1.57)), PTB (1.12 (1.00-1.25)), SGA (1.17 (1.09-1.25)), stillbirth (1.32 (1.09-1.60)), maternal mortality (2.01 (1.12-3.61)), gestational diabetes (1.71 (1.19-2.46)), and pre-eclampsia (1.34 (1.16-1.56)). Stronger associations were noted earlier in pregnancy for low Hb and adverse birth outcomes while the role of timing of high Hb was inconsistent. Lower Hb cutoffs were associated with greater odds of poor outcomes; for high Hb, data were too limited to identify patterns. Information on anemia etiology was limited; relationships did not vary by iron-deficiency anemia.

CONCLUSION

Both low and high maternal Hb concentrations during pregnancy are strong predictors of adverse maternal and infant health outcomes. Additional research is needed to establish healthy reference ranges and design effective interventions to optimize maternal Hb during pregnancy.

Outcome of pregnancy in women with splenomegaly

BACKGROUND

The spleen is a lymphopoietic organ, contains almost one quarter of the body's lymphocytes.

METHOD

This was a prospective cross sectional study, carried out at Kassala hospital, Sudan between 1st of May 2019 to 30th of April 2020. The objective of this study was to investigate the outcome of pregnancy in women with splenomegaly. A total coverage of 57 women with splenomegaly were approached among all pregnant women attending the hospital and asking for care. An enlarged spleen detected by palpation and subcategorized into mild, moderate and severe one according to its length below the left costal margin using Ultrasound. Data was collected using structured questionnaire. Means and proportions were compared between the groups of the study-using student and x² test, and P < 0.05 was considered significant.

RESULTS

The most predominant type of splenomegaly was massive (50.9%) splenomegaly. The reported obstetric complications among the investigated women include: intrauterine growth restriction (19.3%), preterm labor ((17.5%), miscarriage (12.3%) and stillbirth (3.5%). Out of 50 patients their pregnancy progressed to delivery, three patients developed primary hemorrhage requiring blood transfusion with ≥ 2 units of blood. Respiratory distress syndrome (RDS), acute tachypnea of the newborn and stillborn babies were observed in 18%, 6% and 4% respectively. Higher proportion of women with poor obstetric outcomes was reported in cases of massive splenomegaly in comparison with other types.

CONCLUSION

The study showed significant association between adverse obstetric outcomes and massive splenomegaly. Thus, it is important to consider splenomegaly as one of the factors making the pregnancy high-risk one.

[Hematologic and nutritional states are associated with the development of preeclampsia in a Mexican population]

Introduction

Introduction: nutrient and trace element deficiency are risk factors for the development of preeclampsia; these nutrients induce changes in the hematologic state, which can be used to prevent complications during pregnancy. Objective: this research will analyze the nutritional and hematological status during the 3 trimesters of gestation in pregnant women with preeclampsia to evaluate its association with gestational alterations. Method: a cross-sectional, descriptive, and analytic study was conducted on 78 pregnant women who attended a prenatal control clinic, 11 of whom were diagnosed with preeclampsia. The hematological parameters were determined through hematometry. To get the nutritional intake profile of the pregnant women, a frequency of food consumption questionnaire was used. Results: the normotensive group´s arterial pressure (PA) was significantly lower than that of pregnant women with preeclampsia. The hematological profile changed during pregnancy, and platelet value was much higher in preeclamptic women. The nutritional status of pregnant women in the third trimester consumed more macronutrients and micronutrients than in the first and second trimesters, and this pattern was observed in pregnant women with preeclampsia. When compared to pregnant women with preeclampsia, normotensive women received more minerals and vitamins. Conclusion: hematological values are modified during each trimester of gestation, and pregnant women with preeclampsia had high platelet values compared to normotensive women. Our data show a greater intake of minerals and vitamins in normotensive pregnant women as compared to those who developed preeclampsia; therefore, it is recommended that pregnant women be provided with nutritional guidance in order to prevent pregnant complications.

Prevalence of Low Birth Weight and its Association With Anemia in White Nile State, Sudan: A Cross-Sectional Study

Introduction

Low birth weight (LBW) remains a global health concern, especially in sub-Saharan African countries with fewer resources, such as Sudan. Despite ongoing preventive measures, LBW is still one of the main health problems and it is a leading risk factor for several adverse perinatal and neonatal outcomes.

Objective

To assess the prevalence of and factors associated (mainly maternal anemia) with LBW at Rabak Maternity Hospital, White Nile, Central Sudan.

Methods

A cross-sectional study was conducted involving live singleton newborns and their mothers who presented to Rabak Maternity Hospital from September to December 2021. Questionnaires were completed via face-to-face interviews to gather maternal information (maternal age, parity, history of miscarriage, educational status, and level of antenatal care [ANC]). Maternal hemoglobin levels were measured using an automated hematology analyzer. The neonate's birth weight and sex were recorded.

Results

Two hundred and fifty-three newborns were enrolled in this study, 40 (15.8%) of whom were LBW neonates. The median (interquartile range) maternal age and parity were 25 (21.0-30.0) years and 2 (1-4), respectively. While gestational age, maternal hemoglobin, and maternal anemia were associated with LBW, maternal age, parity, a history of miscarriage, education level, and level of ANC were not associated with LBW in the univariate analysis. Multivariate analysis showed that gestational age (adjusted odds ratio [AOR] = 0.80, 95% confidence interval [CI] = 0.66-0.96) and maternal hemoglobin (AOR = 0.76, 95% CI = 0.52-0.86) were inversely associated with LBW. Maternal anemia was associated with LBW (AOR = 4.70, 95% CI = 2.06-10.94).

Conclusion

LBW is a major health concern in White Nile, Sudan. Maternal age and maternal anemia are associated with LBW. Preventive measures for managing maternal anemia may help reduce the incidence of LBW.

Preeclampsia development and neonatal outcomes in pregnant women who were anemic in the first trimester

Background/Aim: Anemia is a disease that can be easily treated, but it is still widespread worldwide. Anemia can affect nearly 40% of women. Anemia has been extensively studied and related to a variety of pregnancy complications. The primary purpose of our study was to discover the relationship between preeclampsia and anemia in the first trimester, and the secondary goal was to analyze the outcomes of newborns born to these mothers. Methods: This study was compiled as a retrospective cohort study. Age, gravida, parity, and thyroid stimulating hormone (TSH) levels were recorded in a patient’s first visit file. Hemoglobin counts in the first trimester were analyzed as hemogram values. Those with a hemoglobin value <11 g/dl during pregnancy were classified as anemic. The patients' file records were reviewed to determine mode of delivery, birth weight, and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores. To confirm a diagnosis of preeclampsia, the American Congress of Obstetricians and Gynecologists (ACOG) criteria were used. Results: After the exclusion of 186 women due to comorbidities and multiple pregnancies, 364 women were evaluated. The number of anemic pregnant women in the first trimester was 87 (23.9%), and 277 non-anemic women were matched with the anemic group. No statistical difference between the groups in terms of demographic characteristics, such as age, gravida, body mass index (BMI), and TSH were found. No statistical difference between the groups in terms of delivery type, infant birth weight, and APGAR scores were found (P > 0.05). Preeclampsia frequency was statistically higher in pregnant women who were anemic in the first trimester (P = 0.032). Conclusion: Preeclampsia was found to be more common in pregnant women who were anemic in the first trimester. Although it would seem that neonatal outcomes are unaffected, we believe that the unaffected outcomes are due to iron replacement. To avoid pregnancy complications, it is crucial for women not to be anemic prior to becoming pregnant.

Mode of Delivery and Neonatal Outcome in Adolescent Pregnancy (13-16 Years Old) Associated with Anemia

Background: Adolescent pregnancy represents an important public-health problem due to its maternal and fetal outcomes. Adolescent patients are predisposed to multiple obstetrical complications, including anemia and preterm birth which has a higher incidence among this population; withal, in the specialty literature, anemia is considered to be a risk factor for preterm delivery; furthermore, multiple studies have demonstrated that a very young age is an independent risk factor for preterm birth. Objectives: The study aims to reveal if anemia during adolescent pregnancy has a negative impact on the time and mode of delivery and newborns’ outcomes. Patients and methods: We performed a retrospective multicentric study on adolescent pregnancy. We analyzed 172 patients aged between 13 and 16 years who delivered in two large tertiary hospitals between 1 October 2018 and 15 April 2022. We divided the patients into two groups—a study group (n = 64) with anemia and a control group (n = 108) without anemia. We evaluated the modes of delivery, the times of birth, and the neonatal outcomes by 1-min newborn’s Apgar score, neonatal intensive-care unit (NICU) admission, and the newborns’ weights. Results: The rate of cesarean section was higher in patients with anemia than in the control group (45.31% vs. 38.88%, p < 0.001). We found that patients between 13 and 16 years diagnosed with anemia have a higher risk of preterm birth than those without anemia (35.93% vs. 21.29%, p < 0.001); however, an increased rate of LBW neonates was observed in the anemic adolescent group ≤14 years (p < 0.001). Regarding the newborns’ 1-min Apgar score, NICU admission, no statistically significant differences were recorded between the two groups according to the severity of anemia. In the anemic patients’ group, prenatal screening was identified in 9.37% of cases, while in the control group, in 16.67% (p = 0.034), which represents negative predictive factors, along with a low socio-economic status for the presence of anemia in young adolescent patients. Conclusions: Anemia is a risk factor for preterm birth, LBW, and cesarean section in young adolescent pregnancy. The association of lack of prenatal care and low socio-economic status worsens maternal and neonatal outcomes.

Prevalence, maternal characteristics, and birth outcomes of preeclampsia: A cross-sectional study in a single tertiary healthcare center in greater Kuala Lumpur Malaysia

Background

Preeclampsia is associated with an increased risk of adverse maternal and perinatal outcomes. This study aimed to assess preeclampsia prevalence in a Malaysian referral maternity hospital and the association between preeclampsia and maternal characteristics and outcomes.

Methods

A cross-sectional study was conducted between January 2010 and December 2020 using secondary data from a single tertiary healthcare center in Greater Kuala Lumpur, Malaysia. A total of 40,212 deliveries were included for analysis to investigate the association between conditions (maternal characteristics and adverse birth outcomes) and preeclampsia. Multivariable logistic regression was conducted to assess the association between multiple independent variables and the outcome variable (preeclampsia).

Results

The reported prevalence of preeclampsia was 1.6%. Pregnant women with preeclampsia had a higher risk of preterm delivery (67.7%), instrumental and cesarean delivery (74.7%), neonatal low birth weight (48.5%), neonatal 5-min Apgar score <7 (18.1%), and neonatal intensive care unit (NICU) admission (19.8%). There were significantly higher odds of developing preeclampsia among nullipara [adjusted odd ratio (adjOR) 1.792, 95% CI: 1.518-2.115], women with a previous history of preeclampsia (adjOR 5.345, 95% CI: 2.670-10.698) and women with multiple pregnancies (adjOR 1.658, 95% CI: 1.071-2.566). However, there is a significant association between maternal characteristic variables. There was a significant association when a combination of variables for risk assessment: the presence of anemia and gestational hypertension effect on preeclampsia (OR 26.344, 95% CI: 9.775-70.993, p < 0.002) and gestational hypertension without anemia on preeclampsia (OR 3.084, 95% CI: 2.240-4.245, p < 0.001). Similarly, an association was seen between chronic hypertension and younger age (<35 years old) on preeclampsia (OR 14.490, 95% CI: 9.988-21.021, p < 0.001), and having chronic hypertension with advanced maternal age (≥35 years old) on preeclampsia (OR 5.174, 95% CI: 3.267-8.195, p < 0.001). Both conditions had increased odds of preeclampsia, in varying magnitudes. Overall, the significant interaction effects suggest that a history of chronic or gestational hypertension has a different relationship to the incidence of preeclampsia depending on the maternal age and anemia status. Pregnant women with preeclampsia had significantly higher odds for preterm delivery (adjOR 6.214, 95% CI: 5.244-7.364), instrumental and cesarean delivery (adjOR 4.320, 95% CI: 3.587-5.202), neonatal low birth weight (adjOR 7.873, 95% CI: 6.687-9.271), 5-min Apgar score <7 (adjOR 3.158, 95% CI: 2.130-4.683), and NICU admission (adjOR 8.778, 95% CI: 7.115-10.830).

Conclusions

Nulliparity, previous history of preeclampsia, and multiple pregnancies were associated with an increased risk of preeclampsia. The presence of different underlying conditions, such as chronic hypertension, anemia, and extremes of maternal age played an important role in increasing preeclampsia risk in the considered study. Larger samples are needed to validate such findings.

Evaluation of the association between haemoglobin levels and preterm birth at Khartoum, Sudan: A hospital-based study

Objective

The objective of this study was to determine the association between haemoglobin level and PB.

Methods

A cross-sectional study was conducted in Khartoum, Sudan. Questionnaires on demographics and medical and obstetric factors were completed. A logistic regression analysis was performed.

Results

Of the 1,716 pregnant women, approximately two-thirds (65.7%) had anaemia (haemoglobin < 11 g/dl) and six (0.3%) had severe anaemia (haemoglobin < 8 g/dl). Of the 1,716 women, 283 (16.5%) had a PB. In multivariable logistic regression, parity (AOR = 1.15, 95% CI = 1.09–1.21, P < 0.001) was positively associated with PB. Compared to those with haemoglobin levels of 10–10.9 g/dl, pregnant women with haemoglobin levels of 8–8.9 (AOR = 0.41, 95% CI = 0.22–0.77), 9–9.9 (AOR = 0.59, 95% CI = 0.38–0.91), and 11–11.9 g/dl (AOR = 0.53, 95% CI = 0.36–0.77) were at a lower risk of PB. Women with haemoglobin levels of 12–13 g/dl were at a higher risk of PB (AOR = 1.62, 95% CI = 1.06–2.45). There was no significant association between women with haemoglobin levels < 8 g/dl and > 13 g/dl and PB.

Conclusion

This study showed different levels of association between haemoglobin levels and PB.

Global Prevalence of Anemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis

BACKGROUND

Anemia is one of the most critical health conditions affecting people worldwide. The disease is silent, with a slow progression and a few physical symptoms. Anemia during pregnancy carries the risk of premature birth, low birth weight, and fetus malformations and can impose additional costs on society and families. Therefore, the aim of this study is to conduct a systematic review and meta-analysis on the prevalence of anemia in pregnant women worldwide.

METHODS

In this work, we have conducted a systematic review and meta-analysis of the studies that have examined the prevalence of anemia in pregnant women globally. The Google Scholar, Cochrane, ScienceDirect, Medline (PubMed), and Web of Science (WoS) databases were searched for articles published between 1991 and 2021. The search keywords were anemia, pregnancy, prevalence, and meta-analysis. In order to analyze the eligible studies, the stochastic effects model was used, and the heterogeneity of the studies was examined using the I² index. Data analysis was performed within the Comprehensive Meta-Analysis software (Version 2).

RESULTS

The search resulted in 338 deduplicated studies, of which 52 studies with a total sample size of 1,244,747 people were included in this review. According to the results of the meta-analysis, the overall prevalence of anemia in pregnant women is 36.8% (95% confidence interval: 31.5-42.4%). The highest prevalence of anemia is mild at 70.8 (95% CI 58.1-81) and highest in the third trimester of pregnancy with the prevalence of 48.8 (95% CI 38.7-58.9), while the highest prevalence of anemia in pregnant women was in Africa with the prevalence of 41.7 (95% CI 32.3-49.4).

CONCLUSION

The results of this study show a high prevalence of anemia among pregnant women worldwide, and the highest of this prevalence is mild anemia. The prevalence of anemia in the third trimester was higher than in the first and second trimesters. Anemia in pregnant women in developing countries is significantly higher than in developed countries due to pregnancy's economic, sociological, and health factors.

Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India

Background

Iron-deficiency anemia is a known risk factor for several adverse perinatal outcomes, but data on its impact on specific maternal morbidities is less robust. Further, information on associations between anemia in early pregnancy and subsequent outcomes are understudied.

Methods

The study population was derived from the Community Level Interventions for Pre-eclampsia (CLIP) trial in Karnataka State, India (NCT01911494). Included were women who were enrolled in either trial arm, delivered by trial end date, and had a baseline measure of hemoglobin (Hb). Anemia was classified by WHO standards into four groups: none (Hb ≥ 11 g/dL), mild (10.0 g/dL ≤ Hb < 11.0 g/dL), moderate (7.0 g/dL ≤ Hb < 10.0 g/dL) and severe (Hb < 7.0 g/dL). Targeted maximum likelihood estimation was used to estimate confounder-adjusted associations between anemia and a composite (and its components) of adverse maternal outcomes, including pregnancy hypertension. E-values were calculated to assess robustness to unmeasured confounding.

Results

Of 11,370 women included, 10,066 (88.5%) had anemia, that was mild (3690, 32.5%), moderate (6023, 53.0%), or severe (68, 0.6%). Almost all women (> 99%) reported taking iron supplements during pregnancy. Blood transfusions was more often administered to those with anemia that was mild (risk ratio [RR] 2.16, 95% confidence interval [CI] 1.31–3.56), moderate (RR 2.37, 95% CI 1.56–3.59), and severe (RR 5.70, 95% CI 3.00–10.85). No significant association was evident between anemia severity and haemorrhage (antepartum or postpartum) or sepsis, but there was a U-shaped association between anemia severity and pregnancy hypertension and pre-eclampsia specifically, with the lowest risk seen among those with mild or moderate anemia.

Conclusion

In Karnataka State, India, current management strategies for mild-moderate anemia in early pregnancy are associated with similar rates of adverse maternal or perinatal outcomes, and a lower risk of pregnancy hypertension and preeclampsia, compared with no anemia in early pregnancy. Future research should focus on risk mitigation for women with severe anemia, and the potential effect of iron supplementation for women with normal Hb in early pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04714-y.

The Association between Maternal Periodontitis and Preterm Birth: A Case-Control Study in a Low-Resource Setting in Sudan, Africa

Background and Objectives: Vast data have been published recently on the association between periodontitis and preterm birth (PB). However, these studies have shown inconsistent results. Few of them were conducted in Africa, and data has not been published on the association between periodontitis and PB in Sudan. Materials and Methods: A case-control study was conducted at the Omdurman maternity hospital in Sudan from February through October 2021. The cases were women with spontaneous PB (<37 weeks), and healthy women with TB (37−42 weeks) were the controls. Questionnaires (demographics, medical and obstetric factors) were completed through face-to-face interviews. Periodontitis was diagnosed by the Community Periodontal Index as: “bleeding on probing and a pocket depth of ≥3 mm and clinical attachment loss of ≥6 mm, calculus with plaque deposits, and gingival recession”. Multivariate regression analysis was performed with PB as the dependent variable. Results: One hundred sixty-five women were enrolled in each arm of the study. The age, parity and body mass index did not significantly differ between the women with PB and those with TB. Compared with the controls, a significantly higher number of women with PB had periodontitis (50/165 (30.3%) vs. 30/165 (18.2%), p = 0.011). The association between periodontitis and PB was significant. Women who had periodontitis had double the odds of having PB compared to women who had no periodontitis (adjusted Odd Ratio = 2.05, 95% Confidence Interval = 1.20−3.52). Moreover, the haemoglobin level (adjusted Odd Ratio = 0.67, 95% Confidence Interval = 0.51−0.88) was inversely associated with PB. Conclusion: The study results indicate that periodontitis and low haemoglobin were strongly associated with PB. Preventive measures, including the use of periodontitis screening and the prevention of anaemia, are needed to reduce PB in this setting.

The prevalence, risk factors and outcomes of anaemia in South African pregnant women: a systematic review and meta-analysis

BackgroundAnaemia is associated with maternal and perinatal morbidity and mortality. The pooled prevalence of anaemia in the South African (SA) pregnant population was ascertained by systematically reviewing available literature. Severity, risk factors (HIV, tuberculosis, race, province, year of study), maternal morbidity and mortality (hypertensive disorders of pregnancy), birth outcomes (including low birth weight) and supplementation during pregnancy were also described.MethodsEligible studies reported on haemoglobin concentration or prevalence of anaemia in a SA pregnant population and were available in full text. Case-control and estimation studies were excluded with no restriction on the date of publication. PubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched, using the keywords 'anaemia', 'haemoglobin', 'pregnancy', 'South Africa'. Risk of bias was conducted using the Hoy tool and the Doi plot and LFK ratio. Overall study quality was assessed using the GRADE tool. Due to heterogeneity amongst studies subgroup analyses were performed (random effects and quality effects model) using MetaXL addon tool for Microsoft Excel.ResultsThe initial search yielded 7010 articles and 26 were selected for inclusion. Twenty studies were cross-sectional, three were longitudinal and one a randomised control trial. Studies ranged in publication year from 1969 to 2020. The pooled prevalence of anaemia in pregnant women in SA was determined to be 31% (95% CI, 23-40%). Hypertensive disorders of pregnancy and low birth weight were associated with anaemia. While iron deficiency was reported as the main cause, other risk factors included HIV and other infections.DiscussionLimitationsThere was limited data reporting on prevalence of anaemia and direct maternal and foetal outcomes. Heterogeneity amongst studies was not explained by subgroup analysis. Majority of cross-sectional study designs reduced the ability to infer causality.InterpretationWhile the prevalence of anaemia remains high and of concern, risk factors are varied. Iron deficiency is still common but the presence of comorbidities also contributes to anaemia and should not be ignored. More longitudinal research into associations between anaemia and birth outcomes is needed due to a lack of available evidence.Systematic review registrationPROSPERO 2020: CRD42020157191.

Maternal anemia and severe maternal morbidity in a US cohort

BACKGROUND

Maternal anemia is a common pregnancy complication and often leads to a requirement for additional treatments and interventions. Identifying the frequency at which women with antenatally diagnosed anemia experience severe morbidity at the time of admission to the labor and delivery unit will guide future recommendations regarding screening and interventions for anemia during pregnancy.

OBJECTIVE

The objective of this study was to evaluate the association between antenatally diagnosed anemia and severe maternal morbidity as defined by the Centers for Disease Control and Prevention in a large, contemporary, US cohort. Neonatal outcomes were also examined.

STUDY DESIGN

This was a secondary analysis of the Consortium on Safe Labor database from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which collected data on 228,438 deliveries in 19 United States hospitals from 2002 to 2008. This analysis included women with viable, singleton gestations and excluded stillbirths and gestations with severe congenital anomalies. Women with a diagnosis of antenatal anemia were compared with those without. Identification of diagnoses of antenatal anemia was obtained via electronic medical record abstraction and International Classification of Diseases coding according to each hospital protocol within the Consortium on Safe Labor. The primary maternal outcome consisted of a composite of severe maternal morbidity as defined by the Centers for Disease Control and Prevention and included maternal death, eclampsia, thrombosis, transfusion, hysterectomy, and maternal intensive care unit admission. The primary neonatal outcome was a composite that included a 5-minute Apgar score of <7, hypoxic ischemic encephalopathy, respiratory distress syndrome, necrotizing enterocolitis, seizures, intracranial hemorrhage, periventricular or intraventricular hemorrhage, neonatal sepsis, neonatal intensive care unit admission, and neonatal death. Each outcome within the composites was assessed individually along with other additional secondary outcomes, including a composite of severe maternal morbidity not including transfusion morbidity. All statistical analyses were performed with Stata version 14.2 (StataCorp LLC, College Station, TX) using Student's t test, chi-square test, Fisher's exact test, and Wilcoxon rank-sum (Mann-Whitney U) test, as appropriate. A multivariable logistic regression was performed with potential confounding variables entered into the regression equation if they differed between groups at a significance level of P<.05.

RESULTS

A total of 166,566 women met the inclusion criteria. From the original cohort, 56,734 women could not be included because of an unknown diagnosis of anemia. Of those included, 10,217 (6.1%) were diagnosed with anemia during the pregnancy. Women with anemia were more likely to be younger, non-Hispanic Black, single, multiparous, and have a higher prepregnancy body mass index than those without anemia. The frequency of the primary maternal composite outcome, the neonatal composite outcome, and other secondary outcomes including the severe maternal morbidity composite not including transfusion, maternal death, transfusion during labor and the postpartum period, hysterectomy, postpartum hemorrhage, infectious morbidity, cesarean delivery, and preterm delivery were more common in women with anemia (P<.05). After multivariable logistic regression analysis adjusting for confounders, higher rates of severe maternal morbidity remained persistently associated with anemia (adjusted odds ratio, 2.04; 95% confidence interval, 1.86-2.23) in addition to the association of anemia with the severe maternal morbidity composite not including transfusion, maternal death, thrombosis, transfusion, hysterectomy, intensive care unit admission, postpartum hemorrhage, hypertensive disorders of pregnancy, cesarean delivery, and infectious morbidity. The composite neonatal outcome also remained associated with anemia after adjusting for confounders (adjusted odds ratio, 1.14; 95% confidence interval, 1.06-1.23).

CONCLUSION

Women with antepartum anemia experienced increased rates of severe maternal morbidity and other serious adverse outcomes. Diagnosis and treatment of anemia during the antepartum period may lead to the identification and treatment of women at higher risk for maternal morbidity and mortality.

Magnitude of Intestinal Parasitosis, Malnutrition, and Predictors of Anemia Among Nonpregnant Reproductive-Age Women Attending Healthcare Services in Olenchity General Hospital, Central Ethiopia

Background

Anemia and malnutrition remain a public health challenge in developing worlds. Anemia during a nonpregnant state is one of the neglected medical conditions affecting reproductive-age women around the world. Globally, it is estimated that one-third of all reproductive-age women are anemic. Although it has negative consequences and extensive burden, anemia in nonreproductive-age women is rarely studied in Africa. In Ethiopia, studies investigating anemia and malnutrition among nonpregnant reproductive-age women are limited. Therefore, this study was aimed to assess intestinal parasitic infection, malnutrition, and predictors of anemia among nonpregnant reproductive-age women in Olenchity General Hospital, central Ethiopia.

Methods

A facility-based cross-sectional study design was employed among 405 nonpregnant reproductive-age women in Olenchity General Hospital, central Ethiopia from February 14 to March 24, 2018. Data were collected using a pretested interviewer-administered questionnaire. Blood samples were collected and tested to determine hemoglobin levels by using a hematology analyzer machine. Collected data were entered into EpiData version 3.02 and exported to SPSS version 20 (IBM SPSS Statistics, 2012) for further analysis. Multivariable logistic regression analysis was done to identify factors independently associated with anemia after controlling for possible confounders. Statistical significance was declared at p-value &lt;0.05.

Result

Overall, the magnitude of anemia was found to be 47.4% [95% CI (42.7, 52.6)], of which 34.8% were mild, 11.4% were moderate, and 1.2% were severely anemic. The prevalence of intestinal parasitic infection, wasting, and overweight was 34.6%, 26.2%, and 8.1%, respectively. Having no formal education [AOR=2.25, CI (1.02, 4.97)], using three to five sanitary pads per day during menses [AOR=1.66 CI (1.02, 2.68)], history of chewing khat [AOR= 4.45, CI (1.18, 16.83)], being from households with mild food insecurity [AOR=3.41, CI (1.10, 10.58)], and intestinal parasitic infection [AOR=2.28, CI (1.39, 3.47)] were factors independently associated with anemia.

Conclusion

The magnitude of anemia, malnutrition, and intestinal parasitic infection among nonpregnant reproductive-age women was found to be a considerable public health problem. Therefore, attention should be given to nonpregnant reproductive-age women visiting different healthcare services to reduce risks of anemia and malnutrition for possible future pregnancies and to ensure women’s health. Deworming of nonpregnant reproductive-age women is also very crucial to reduce the risks of anemia.

Prevalence of iron and folic acid supplements consumption and associated factors among pregnant women in Eswatini: a multicenter cross-sectional study

Background

During pregnancy, nutritional requirements increase and if not met, pregnancy-related complications may manifest. To prevent these undesirable outcomes, the World Health Organization recommends daily oral iron and folic acid (IFA) supplementation as part of antenatal care. Despite this recommendation, the use of IFA supplements is still very low in several developing countries. Additionally, no prior information exists regarding the level of consumption of IFA in Eswatini. Thus, this study aimed to determine the prevalence of consumption of IFA supplements and to identify factors associated with the consumption of IFA supplements among pregnant women in Eswatini.

Methods

A cross-sectional questionnaire survey was conducted among 330 pregnant women aged ≥ 18 years in their third trimester in Eswatini. Participants were recruited from eight purposively selected healthcare facilities from July 2019 to October 2019. Good consumption was defined as consuming all or almost all IFA supplements throughout pregnancy.

Results

During the first trimester, 10.3 % of the participants consumed all or almost all IFA supplements. In the second and third trimesters, those who consumed all or almost all supplements were 37 and 39.7 %, respectively, for iron and 37.6 and 40.9 %, respectively, for folic acid. Barriers, including side effects, forgetfulness, safe previous pregnancies without IFA, others’ advice against consumption, IFA stock-outs, inability to meet transport costs, and inadequate supply of IFA tablets, contribute to low consumption of IFA. Multivariate logistic regression models showed that the barriers were inversely associated with good consumption of IFA supplements. Better knowledge and attitude toward IFA and older maternal age were positively associated with good consumption of IFA supplements.

Conclusions

Low consumption of IFA supplements in overall pregnancy is mainly owing to the late antenatal care attendance. Strategies such as establishing a preconception care unit and school-based provision of IFA may be helpful. It is evident that most women still lack knowledge, and some have negative attitudes about IFA supplements. Health education to raise awareness and emphasize the importance of starting antenatal care early as well as consuming supplements on time should be revisited and intensified. Multiple strategies such as including community health care workers for distributing IFA supplements, discussing with clients about the measures to reduce forgetfulness, advising ways to prevent and manage the side effects, providing subsidies to cover transport costs, and ensuring adequate supply of IFA supplements in facilities may need to be employed to reduce the identified barriers.

Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

Background

Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care.

Methods

Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically.

Results

A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants.

Conclusions

Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03735-3.

Gestational hypertension and progression towards preeclampsia in Northern Ethiopia: prospective cohort study

BACKGROUND

Preeclampsia (PE) is one of the main causes of medical complication of pregnancy and is the main cause of perinatal mortality and morbidity. It is one of the top causes of maternal mortality in Ethiopia. Also known as transient hypertension, gestational hypertension (GH) is increased blood pressure during pregnancy without proteinuria, which is expected to return to normal by the 12th-week postpartum visit. PE is GH with proteinuria and /or other systemic manifestations. Evidence from high income countries show that GH significantly progresses towards PE. To our knowledge, this is the first study on the progression of GH towards PE in an African setting. The objective of this study is, therefore, to assess the incidence of GH, progression towards PE and factors associated with progression in Ethiopia.

METHODS

This is a prospective cohort study conducted at Ayder Comprehensive Specialized Hospital (ACSH) and Mekelle General Hospital (MGH), the largest referral centers in Northern Ethiopia. Two hundred and forty women with GH were enrolled and followed up until delivery. Clinical and laboratory data at initial presentation and at follow-up were compared among women who progressed towards PE and who remained with the diagnosis of GH. Logistic regression analysis was employed to model the combined effects of the clinical and laboratory data as significant predictors of progression from GH to PE.

RESULT

The incidence of GH in this study was 6 % (4.9-8.5). The rate of progression was 17.1 % (13.4-23.8). Previous history of GH, anemia during pregnancy, previous second-trimester spontaneous abortion were significant predictors of progression.

CONCLUSIONS

There is a high rate of progression of GH towards PE. In a resource-limited setting where predictive and diagnostic tools are scarce, clinical profile of women should be taken into consideration for prediction and diagnosis of PE.

Maternal Knowledge Associated with the Prevalence of Iron and Folic Acid Supplementation Among Pregnant Women in Muntinlupa, Philippines: A Cross-Sectional Study

PURPOSE

The World Health Organization advocates that all pregnant women in areas where anemia is prevalent receive supplements of iron and folic acid. However, owing to a myriad of factors, the uptake of iron and folic acid supplementation (IFAS) is still low in many countries. Therefore, this study was conducted to assess the prevalence of IFAS and its associated factors among pregnant women.

PATIENTS AND METHODS

A cross-sectional study was conducted at a hospital in Muntinlupa, Philippines, between March and August 2019 among 280 pregnant women. A systematic random sampling technique was used to select participants. Data were collected using interviewer-administered questionnaires. Multivariable logistic regression analyses were employed to identify factors associated with the prevalence of IFAS among pregnant women.

RESULTS

Among 280 pregnant women, a majority (85.6%, n= 238) took IFAS during pregnancy. Among the respondents, 128 (45.9%) women had knowledge about signs and symptoms of anemia, 126 (45.3%) had knowledge of the benefits associated with IFAS, and 42 (15.4%) had knowledge about side effects associated with IFAS. The main sources of information about IFAS were health care providers (41.8%), followed by community health workers (CHWs) (14.6%). Maternal knowledge concerning IFAS benefits (OR = 2.50, CI = 1.04-5.97, p=0.04) was positively associated with the prevalence of IFAS.

CONCLUSION

Maternal knowledge about the benefits of taking IFAS was significantly associated with the prevalence of IFAS among pregnant women in Muntinlupa, Philippines. There is a pressing need to improve health education on the benefits of IFAS among pregnant women to increase its prevalence. This emphasizes the necessity of increased involvement of health care providers and CHWs to increase women's knowledge of IFAS benefits and support them through pregnancy.

Advanced maternal age impacts physiologic adaptations to pregnancy in vervet monkeys

The trend to delay pregnancy in the USA has resulted in the number of advanced maternal age (AMA) pregnancies to also increase. In humans, AMA is associated with a variety of pregnancy-related pathologies such as preeclampsia (PE). While AMA is known to be a factor which contributes to the development of pregnancy-induced diseases, the molecular and cellular mechanisms giving rise to this phenomenon are still very limited. This is due in part to lack of a preclinical model which has physiologic relevance to human pregnancy while also allowing control of environmental and genetic variability inherent in human studies. To determine potential physiologic relevance of the vervet/African green monkey (Chlorocebus aethiops sabaeus) as a preclinical model to study the effects of AMA on adaptations to pregnancy, thirteen age-diverse pregnant vervet monkeys (3-16 years old) were utilized to measure third trimester blood pressure (BP), complete blood count, iron measurements, and hormone levels. Significant associations were observed between third trimester diastolic BP and maternal age. Furthermore, the presence of leukocytosis with enhanced circulating neutrophils was observed in AMA mothers compared to younger mothers. Moreover, we observed a negative relationship between maternal age and estradiol, progesterone, and cortisol levels. Finally, offspring born to AMA mothers displayed a postnatal growth retardation phenotype. These studies demonstrate physiologic impairment in the adaptation to pregnancy in AMA vervet/African green monkeys. Our data indicate that the vervet/African green monkey may serve as a useful preclinical model and tool for deciphering pathological mediators of maternal disease in AMA pregnancy.

Systematic and meta-analysis of factors associated with preeclampsia and eclampsia in sub-Saharan Africa

Background

Preeclampsia and eclampsia are common complications of pregnancy globally, including sub-Saharan African (SSA) countries. Although it has a high burden on maternal and neonatal mortality and morbidity, evidence on the risk of the problem is limited. Therefore, the aim of this review was to examine the factors associated with preeclampsia and eclampsia among mothers in SSA countries.

Methods

We searched article from SSA countries using electronic database MEDLINE, EMBASE, PubMed, CINAHL published in English from January 2000 to May 2020. Two reviewers independently screened, extracted and assessed the quality of the articles. Both random and fixed effect model were used for analysis. Heterogeneity of the studies and publication bias were checked. STATA 16 used for analysis.

Results

Fifty-one studies met the inclusion criteria and included in this review. The following factors were identified through meta-analysis: being primiparous (OR: 2.52; 95% CI:1.19, 3.86), previous history of maternal preeclampsia/eclampsia (OR:5.6; 95% CI:1.82, 9.28), family history of preeclampsia/eclampsia (OR:1.68; 95% CI:1.26, 2.11), high maternal body mass index (OR: 1.69; 95% CI:1.17, 2.21), chronic hypertension (OR: 2.52; 95% CI:1.29, 3.74), anaemia during pregnancy (OR: 3.22; 95% CI:2.70, 3.75) and lack of antenatal care visits (OR: 2.71; 95% CI:1.45, 3.96). There was inconclusive evidence for a relationship with a number of other factors, such as nutrition and related factors, antenatal care visits, birth spacing, and other factors due to few studies found in our review.

Conclusions

The risk of preeclampsia and eclampsia is worse among women who have a history of preeclampsia/eclampsia (either themselves or family members), primiparous, obesity and overweight, living with chronic disease, having anaemia during pregnancy and absence from ANC visits. Therefore, investment must be made in women’s health needs to reduce the problem and health service providers need to give due attention to high-risk women.

Anemia in the first trimester is associated with anemia during pregnancy in Sidotopo Wetan Community Health Center, Surabaya

Objective: To analyze association between anemia in the first trimester and preeclampsia during pregnancy in Sidotopo Wetan Community Health Center Surabaya.Materials and Methods: This study was a analytic case control study. The samples were 49 women with preeclampsia as case group and 49 women non-preeclampsia as control group. The data were secondary data collected from medical record of pregnancy women on Sidotopo Wetan Community Health Center Surabaya from January 2016 – Desember 2017. The analysis was done by Chi Square Statistics.Results: 79,6% women in preeclampsia group and 93.9% women in non-preeclampsia group was not anemia in the first trimester. There is association between anemia in the first trimester and preeclampsia during pregnancy in Sidotopo Wetan Community Health Center Surabaya (p = 0.037; OR = 3.932 (CI 95% = 1.010 – 15.303)).Conclusion: There is association between anemia in the first trimester and preeclampsia during preg-nancy in Sidotopo Wetan Community Health Center Surabaya.

Maternal and Perinatal Morbidity and Mortality Associated With Anemia in Pregnancy

OBJECTIVE

To estimate the incidence of anemia in pregnancy and compare the maternal and perinatal outcomes of women with and without anemia.

METHODS

We conducted a population-based retrospective cohort study on all pregnant women in British Columbia who had a live birth or stillbirth at or after 20 weeks of gestation between 2004 and 2016. Women were diagnosed with anemia based on two criteria: third-trimester hemoglobin value or a delivery admission diagnosis of anemia (made before delivery). Anemia was categorized into no anemia (hemoglobin 11 g/dL or greater), mild (9-10.9 g/dL), moderate (7-8.9 g/dL), severe (less than 7 g/dL), or anemia of unspecified severity (with diagnosis made before delivery). Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% CIs expressing the association between anemia and maternal and perinatal outcomes.

RESULTS

Of 515,270 women in the study population, 65,906 (12.8%) had anemia: 11.8%, 0.43%, and 0.02% had mild, moderate, and severe anemia, respectively, and 0.58% had anemia of unspecified severity. Anemic women had longer hospitalization duration and more antenatal admissions, and rates of preeclampsia, placenta previa and cesarean delivery were higher among women with anemia. The intrapartum-postpartum blood transfusion rate was 5.1 per 1,000 among women without anemia, and higher among women with anemia (aOR 2.45, 95% CI 1.74-3.45 for mild anemia; 21.3, 95% CI 12.2-37.3 for moderate anemia; not analyzable for severe anemia; and 48.3, 95% CI 6.60-353.9 for anemia of unspecified severity). Anemia was associated with preterm birth (mild anemia, aOR 1.09, 95% CI 1.05-1.12; moderate anemia, aOR 2.26, 95% CI 2.02-2.54; anemia of unspecified severity, aOR 2.27, 95% CI 2.06-2.50), small-for-gestational-age live birth, low 5-minute Apgar score, neonatal death, and perinatal death.

CONCLUSION

Maternal anemia in pregnancy represents a common and potentially reversible risk factor associated with antepartum, intrapartum, and postpartum maternal morbidity and perinatal morbidity and mortality.

The Association between Iron-deficiency Anemia and Adverse Pregnancy Outcomes: A Retrospective Report from Pakistan

Background

Anemia is one of the most common conditions that affect pregnancies, with dietary iron deficiency being its most common cause. Maternal anemia has been associated with increased risks of both maternal and neonatal adverse outcomes. This study aimed to analyze the maternal and neonatal outcomes in women with third-trimester anemia.

Methods

This was a retrospective report from a Pakistani public hospital. It included data records of the childbirths in the hospital, with at least one record that documented the hemoglobin (Hb) level in women in the first or second trimester and one in the third trimester. The duration of the study was from January 1, 2019 to June 30, 2019. Women with Hb level of <10mg/dL in the third trimester were categorized as anemic, and those with Hb level of >10mg/dL were categorized as non-anemic. Pregnancy outcomes were assessed for both mothers and babies. All data were processed through SPSS version 21.0 for Windows (IBM Corp., Armonk, NY).

Results

The study evaluated 235 (37.8%) anemic and 387 (62.2%) non-anemic women. Adverse maternal outcomes were compared between the two groups. In anemic women, gestational hypertension (56% vs. 27%; p: <0.0001), preeclampsia (65% vs. 25%; p: <0.0001), antepartum hemorrhage (32% vs. 19%; p: =0.0001), postpartum hemorrhage (79% vs. 28%; p: <0.0001), transfusions (94% vs. 5%; p: <0.0001), prolonged/obstructed labor (49% vs. 20%; p: <0.000), urgent induction of labor (24% vs. 2%; p: <0.0001), and urgent caesarean section (CS) (45% vs. 29%; p: 0.0001) were significantly more common as compared to non-anemic women. Adverse neonatal outcomes such as low birth weight (LBW) (59% vs. 29%; p: <0.0001), small-for-gestational-age (SGA) (73% vs. 23%; p: <0.0001), preterm delivery (39% vs. 15%; p: <0.0001), stillbirth (8% vs. 3%; p: 0.01), and early neonatal death (9% vs. 2%; p: 0.000) were associated more with anemia. There was no report of maternal mortality in either group.

Conclusion:

Anemia in the third trimester of pregnancy is associated with adverse maternal and neonatal outcomes including neonatal death. Efforts are required to ensure adequate maternal nutritional status in order to prevent poor outcomes.

Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis

Maternal anemia is a well‐recognized global health problem; however, there remain questions on specific hemoglobin (Hb) thresholds that predict health risk or protection for mother and child. We conducted a systematic review and meta‐analysis to examine the associations of maternal Hb concentrations with a range of maternal and infant health outcomes, accounting for the timing of measurement (preconception, and first, second, and third trimesters), etiology of anemia, and cutoff category. The systematic review included 272 studies and the meta‐analysis included 95 studies. Low maternal Hb (<110 g/L) was associated with poor birth outcomes (low birth weight, preterm birth, small‐for‐gestational‐age (SGA), stillbirth, and perinatal and neonatal mortality) and adverse maternal outcomes (postpartum hemorrhage, preeclampsia, and blood transfusion). High maternal Hb (>130 g/L) was associated with increased odds of SGA, stillbirth, preeclampsia, and gestational diabetes. Relationships varied by the timing of measurement and cutoff category (stronger associations with lower cutoffs); limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long‐term child health outcomes. Current data are insufficient for determining if revisions to current Hb cutoffs are required. Pooled high‐quality individual‐level data analyses, as well as prospective cohort studies, would be valuable to inform the reevaluation of Hb cutoffs.

Maternal anemia and birth weight: A prospective cohort study

OBJECTIVE

To investigate the association between maternal anemia and low/insufficient birth weight.

DESIGN

A prospective cohort study of pregnant women who underwent prenatal care at the healthcare units in a municipality of northeast Brazil together with their newborn infants was carried out. The pregnant women were classified as having anemia when the hemoglobin level was below 11 g/dl. Infants who were born full term weighing less than 2500 grams were classified as low birth weight, and those weighing between 2500 and 2999 grams were classified as insufficient weight. The occurrence of maternal anemia and its association with birth weight was verified using crude and adjusted Relative Risk (RR) estimates with their corresponding 95% confidence intervals (95%CIs).

RESULTS

The final sample was comprised of 622 women. Maternal anemia was considered a risk factor for low/insufficient birth weight, after adjusting the effect measurement for maternal age, family income, urinary infection, parity, alcoholic beverage consumption during pregnancy and gestational body mass index: RRadjusted = 1.38 [95% CI: 1.07 to 1.77].

CONCLUSIONS

Maternal anemia was associated with low/insufficient birth weight, representing a risk factor for the gestational outcomes studied.

Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis

Background

Anemia during pregnancy is a public health problem especially in developing countries and it is associated with maternal and perinatal adverse outcomes. There is no meta-analysis on anemia during pregnancy in Sudan. The current systemic review and meta-analysis was conducted to assess the prevalence, types and determinant of anemia during pregnancy in Sudan.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. The databases (PubMed, Cochrane Library, Google Scholar, CINAHL, and African Journals Online) were searched using; anemia, pregnancy related anemia and Sudan. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Modified Newcastle – Ottawa quality assessment scale were used for critical appraisal of studies. The pooled Meta logistic regression was computed using OpenMeta Analyst software.

Results

Sixteen cross-sectional studies included a total of 15, 688 pregnant women were analyzed. The pooled prevalence of anemia among pregnant women in Sudan was 53.0% (95%, CI = 45.9–60.1). The meta-analysis showed no statistical significant between the age (mean difference = 0.143, 95 CI = − 0.033 − 0.319, P = 0.112), parity (mean difference = 0.021, 95% CI = − 0.035 − 0.077, P = 0.465) between the anemic and no anemic women. Malaria was investigated in six studies. Pregnant women who had malaria infection during pregnancy were 1.94 times more likely to develop anemia than women who had no malaria infection (OR = 1.94, 95% CI =1.33–2.82). Six (37.5%) studies investigated type of anemia. The pooled prevalence of iron deficiency anemia (IDA) among pregnant women in Sudan was 13.6% (95% CI = 8.9–18.2).

Conclusion

There is a high prevalence of anemia among pregnant in the different region of Sudan. While age and parity have no association with anemia, malaria infection was associated with anemia. Interventions to promote the strengthening of antenatal care, and access and adherence to nutrition, and malaria preventive measures are needed to reduce the high level of anemia among pregnant women in Sudan.

Electronic supplementary material

The online version of this article (10.1186/s12878-018-0124-1) contains supplementary material, which is available to authorized users.

Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis

Objective: To systematically analyze the relationship between maternal anemia and low birth weight. Methods: A search of studies was conducted in the main databases (Medline, Embase, Scopus, Web of Science, SciELO, and Lilacs), the gray literature, and the reference lists of selected articles. Cohort and case-control studies that met the eligibility criteria were included in the review. There was no limitation on the language or date of publication. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects, subgroup analyses and meta-regressions were performed. Publication bias was measured using Egger regression and visual funnel plot inspection. Results: A total of 7243 articles were found, of which 71 comprised the systematic review and 68 were included in the meta-analyses. Maternal anemia was associated with low birth weight with an adjusted OR: 1.23 (95% CI: 1.06–1.43) and I²: 58%. The meta-regressions confirmed that the sample size and the methodological quality may partially explain the statistical heterogeneity. Conclusions: Maternal anemia was considered a risk factor for low birth weight.

Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis

OBJECTIVE

To systematically analyze the relationship between maternal anemia and low birth weight.

METHODS

A search of studies was conducted in the main databases (Medline, Embase, Scopus, Web of Science, SciELO, and Lilacs), the gray literature, and the reference lists of selected articles. Cohort and case-control studies that met the eligibility criteria were included in the review. There was no limitation on the language or date of publication. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects, subgroup analyses and meta-regressions were performed. Publication bias was measured using Egger regression and visual funnel plot inspection.

RESULTS

A total of 7243 articles were found, of which 71 comprised the systematic review and 68 were included in the meta-analyses. Maternal anemia was associated with low birth weight with an adjusted OR: 1.23 (95% CI: 1.06⁻1.43) and I²: 58%. The meta-regressions confirmed that the sample size and the methodological quality may partially explain the statistical heterogeneity.

CONCLUSIONS

Maternal anemia was considered a risk factor for low birth weight.

Maternal haemoglobin concentration and risk of preterm birth in a Chinese population

The aim was to examine the relationship between maternal haemoglobin (Hb) concentrations and risk of preterm birth by secondary analysis of data from a randomised controlled trial. This analysis included 10,430 women who were at least 20 years old and no more than 20 weeks of gestation. Results revealed neither first- nor second-trimester Hb concentrations were associated with the risk of preterm births. However, the risk of preterm birth increased when the Hb level was low (<130 g/L) in the first but high (≥130 g/L) in the second trimester, regardless of supplement type (iron-containing: AOR: 2.26, 95% CI: 1.37-3.73; non-iron-containing: AOR: 2.16, 95% CI: 1.11-4.21). In conclusion, maternal Hb concentrations were not associated with the risk of preterm birth. A low-Hb level in the first trimester but coupled with a high Hb level in the second was associated with an elevated risk of preterm birth. Impact statement What is already known on this subject: The relationship between maternal Hb concentration and preterm birth remains inconclusive. Some studies have shown an association between a low- or a high-Hb level and an increased risk of preterm birth. Others have not found such an association. Yet others have shown a U-shaped relationship. What do the results of this study add: Overall, maternal Hb concentrations in first or second trimester were not statistically associated with the risk of preterm birth. However, women with a low Hb concentration in the first trimester together with a high Hb concentration in the second trimester had an increased risk of preterm birth, compared to women who had a higher Hb concentration in the first trimester that remained similar during the second trimester. What are the implications are of these findings for clinical practice and/or further research: Our finding helps identify mothers who are at risk of having a preterm delivery. Investigating the underlying clinical causes of the unfavourable change in Hb levels and close follow-up to these women may help improve birth outcomes.

Association of serum concentrations of persistent organic pollutants (POPs) and risk of pre-eclampsia: a case-control study

BACKGROUND

There is increasing evidence that persistent organic pollutants (POPs) may contribute to pre-eclampsia. The objective of this study was to evaluate the association between Polychlorinated Biphenyls (PCBs) and Polybrominated Diphenyl Ethers (PBDEs) as POPs with pre-eclampsia.

METHODS

This case-control study was performed in the three general university hospitals of Tehran University of Medical Sciences. Serum samples were collected from cases (n = 45) who had diagnosed with preeclampsia and from control samples (n = 70) with normal pregnancy and attended the same hospital for a routine prenatal visit at the third trimester of pregnancy. Pollutants levels were analyzed by Gas Chromatography Mass Spectrometry (GC/MS).

RESULTS

Mean participant age was 27.3 ± 5.39 with median 27. As the main independent variable, total POPs manifested with adjusted OR equal to 1.54 (95 % CI: 1.26-1.87, p-value <0.0001), which was significantly associated with pre-eclampsia. The adjusted OR proved a statistically significant association between total PCBs 1.77 (95 % CI: 1.34-2.32) and total PBDEs (OR = 2.19; 95 % CI: 1.39-3.45, p-value = 0.001) with pre-eclampsia considering confounding variables (maternal age, pre-pregnancy body mass index (BMI), gestational age, weight gain during pregnancy and total lipids in maternal serum). Finally, pre-pregnancy BMI and weight gain during pregnancy had a positive association with pre-eclampsia and gestational age yielded a negative association with pre-eclampsia in all analysis.

CONCLUSION

Our data indicate the association between total POPs, total PBDEs, and total PCBs with pre-eclampsia, even after controlling for the effects of a number of potentially confounding factors. Further investigation about route of exposure and the trend of POPs especially in pregnant women is needed.

O Blood Group as Risk Factor for Preeclampsia among Sudanese Women

AIM

To investigate blood groups and the other possible risk factors for preeclampsia among Sudanese women.

MATERIAL AND METHODS

A case - control study was conducted at Saad Abualila Hospital, Khartoum, Sudan during the period of July 2013 through December 2014. The cases were women with preeclampsia and healthy pregnant women were the controls.

RESULTS

Two hundred eighty pregnant women were enrolled (140 in each arm of the study). Around one-quarter of all women (280) were primiparae (74.0, 26.4%), the majority were housewives (201, 71.7%). Seventy-nine (28.2%) were illiterate or had no informal education. Around half of the women (130, 46.4%) had O blood group. Binary logistic regression showed association between preeclampsia and lack of antenatal care (OR = 2.75, 95% CI = 1.172-6.494, P = 0.020) as well as O blood group (OR = 1.78, 95% CI = 1.088-2.934, P=0.022).

CONCLUSION

The current study showed that women with blood group O were at higher risk of preeclampsia.

Patterns of Esophageal Cancer in the National Cancer Institute at the University of Gezira, in Gezira State, Sudan, in 1999-2012

BACKGROUND

Esophageal cancer (EC) is among the most common malignancies in Eastern Africa, but the occurrence of EC in Sudan has rarely been described in the scientific literature. This paper reports the results of a consecutive case series of all EC patients who visited one of the two public cancer treatment centers in the country in 1999-2012, providing a first description of this disease in a treatment center located in central Sudan.

MATERIALS AND METHODS

Clinical and demographic data for all EC patients who visited the Department of Oncology of the National Cancer Institute at the University of Gezira (NCI-UG) from 1999 to the end of 2012 were abstracted and tabulated by sex, tumor type and other characteristics.

RESULTS

A total of 448 EC patients visited NCI-UG in 1999-2012, and the annual number of EC cases increased steadily from 1999. Squamous cell carcinoma (SCC) was the predominant EC tumor type (90%), and adenocarcinoma (ADC) was reported in 9.4% of the EC cases. The overall male-to-female ratio for EC was 1:1.8, but the ratio was tumor type-dependent, being 1:2 for SCC and 2:1 for ADC. Only 20% of EC patients reported having ever used tobacco and/or alcohol, and the vast majority of these patients were male. At the time of EC diagnosis, 47.3% of the patients resided in Gezira State. Some EC patients from Gezira State seek out-of-state treatment in the national capital of Khartoum instead of visiting NCI-UG.

CONCLUSIONS

The annual number of EC patients visiting NCI-UG has increased in recent years, approximately half of these patients being from Gezira State. Although this consecutive series of EC patients who visited NCI-UG was complete, it did not capture all EC patients from the state. A population- based cancer registry would provide more complete data required to better understand EC patterns and risk factors.

Effect of indoor air pollution from biomass and solid fuel combustion on symptoms of preeclampsia/eclampsia in Indian women

Available evidence concerning the association between indoor air pollution (IAP) from biomass and solid fuel combustion and preeclampsia/eclampsia is not available in developing countries. We investigated the association between exposure to IAP from biomass and solid fuel combustion and symptoms of preeclampsia/eclampsia in Indian women by analyzing cross-sectional data from India's third National Family Health Survey (NFHS-3, 2005-2006). Self-reported symptoms of preeclampsia/eclampsia during pregnancy such as convulsions (not from fever), swelling of legs, body or face, excessive fatigue or vision difficulty during daylight, were obtained from 39,657 women aged 15-49 years who had a live birth in the previous 5 years. Effects of exposure to cooking smoke, ascertained by type of fuel used for cooking on preeclampsia/eclampsia risk, were estimated using logistic regression after adjusting for various confounders. Results indicate that women living in households using biomass and solid fuels have two times higher likelihood of reporting preeclampsia/eclampsia symptoms than do those living in households using cleaner fuels (OR = 2.21; 95%: 1.26-3.87; P = 0.006), even after controlling for the effects of a number of potentially confounding factors. This study is the first to empirically estimate the associations of IAP from biomass and solid fuel combustion and reported symptoms suggestive of preeclampsia/eclampsia in a large nationally representative sample of Indian women and we observed increased risk. These findings have important program and policy implications for countries such as India, where large proportions of the population rely on polluting biomass fuels for cooking and space heating. More epidemiological research with detailed exposure assessments and clinical measures of preeclampsia/eclampsia is needed in a developing country setting to validate these findings.