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Tikmani SS, Mårtensson T, Khalid S, Uzair M, Ali Q, Rahim A, Mårtensson A, Saleem S, Brown N. Assessing the diagnostic accuracy of postnatal clinical scoring methods and foot length measurement for estimating gestational age and birthweight of newborns in low- and middle-income countries: a systematic review and meta-analysis. BMJ Paediatr Open 2024; 8:e002717. [PMID: 39214548 PMCID: PMC11367336 DOI: 10.1136/bmjpo-2024-002717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND This study aimed to update systematic reviews and meta-analyses on the diagnostic accuracy of postnatal clinical scoring (PCS) methods and foot length (FL) measurement for assessing gestational age (GA) and birth weight in low-income and middle-income countries (LMICs). In addition, the quality of reference standards, including antenatal ultrasound (A-US), last menstrual period (LMP), PCS and newborn weighing scales, was also evaluated. METHODS Studies from LMICs published between January 2000 and February 2024 were searched, using databases such as PubMed, Web of Science, Cochrane Library, CINAHL and Scopus. Studies that compared PCS and/or FL with LMP and/or A-US to estimate GA or used calibrated newborn weighing scales for birthweight estimation were included. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-II tool and evaluated the quality of the reference standards. When sufficient data were available, pooled estimates were calculated using random-effects models. RESULTS A total of 50 studies were included. A-US was a reasonable tool for GA assessment if conducted by physicians using fetal biometry and the Hadlock method for GA estimation. LMP was reasonable when women had regular cycles, knew their LMP, were not using contraceptives and LMP data were collected by healthcare providers. When A-US was used as the reference standard, PCS methods estimated GA with a precision of ±2.8 to ±3.2 weeks. FL measurement <7.5 cm showed a pooled sensitivity of 76.2% and specificity of 36.6% for identifying preterm birth. FL measurement ≤7.6 cm had a pooled sensitivity of 78.6% and specificity of 65.7% for identifying low birth weight (LBW). High heterogeneity across studies was observed. CONCLUSION This systematic review and meta-analysis highlights significant variability and methodological inconsistencies in using PCS methods and FL measurement for estimating GA and LBW in LMICs. The observed high heterogeneity across studies suggests a cautious interpretation of the results. PROSPERO REGISTRATION NUMBER CRD42020209455.
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Affiliation(s)
- Shiyam Sunder Tikmani
- Global health and migration unit, Department of Women’s & Children’s Health, Uppsala University, Uppsala, Sweden
- Population and Reproductive Health Section, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Thomas Mårtensson
- Global health and migration unit, Department of Women’s & Children’s Health, Uppsala University, Uppsala, Sweden
| | - Sumaira Khalid
- Department of Public Health, College of Health Professions Marshall University, Huntington, West Virginia, USA
| | - Muhammad Uzair
- Population and Reproductive Health Section, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Qammerulanissa Ali
- Population and Reproductive Health Section, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Anum Rahim
- Epidemiology and Biostatistic Section, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Andreas Mårtensson
- Global health and migration unit, Department of Women’s & Children’s Health, Uppsala University, Uppsala, Sweden
| | - Sarah Saleem
- Population and Reproductive Health Section, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Nick Brown
- Global health and migration unit, Department of Women’s & Children’s Health, Uppsala University, Uppsala, Sweden
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Garlapati S, Venigalla N, Mane S, Dharmagadda A, Sravanthi K, Gupta A. Correlation of Zinc and Copper Levels In Mothers and Cord Blood of Neonates With Prematurity and Intrauterine Growth Pattern. Cureus 2024; 16:e63674. [PMID: 39092406 PMCID: PMC11293485 DOI: 10.7759/cureus.63674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Background Trace elements like zinc and copper are indispensable for human growth and development, exerting significant influence on a multitude of physiological processes. Acting as pivotal components for transcription factors and catalytic cofactors for enzymes, these elements play essential roles in cellular differentiation and maturation Objective The objective of this study was to study serum zinc and copper levels in mothers and neonates in relation to prematurity and intrauterine growth retardation (IUGR). Methods This was a cross-sectional study that included 100 mothers who met the inclusion criteria. Maternal history was recorded, and gestational age was estimated using the New Ballard scoring system. Maternal and cord blood samples were taken for zinc and copper analysis. Results The comparison of maternal copper and zinc levels between term and preterm neonates revealed a statistically significant difference with both trace elements found in less concentration in preterm when compared to the term patients (p= 0.03 for Zinc; 0.0001 for copper). We also report a statistically significant difference in maternal and cord blood copper and zinc levels in cases with IUGR compared to normal neonates. Conclusion The findings show that maternal zinc and copper levels are critical for the intrauterine growth of the fetus and for appropriate gestational age.
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Affiliation(s)
- Srinija Garlapati
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | | | - Shailaja Mane
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Amulya Dharmagadda
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Kasireddy Sravanthi
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Aryan Gupta
- Pediatric Neurology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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Ramijinni RR, Mahajan A, Sapehia D, Singh P, Suri V, Kaur J. Association of Altered Ratio of Maternal Folic Acid and Vitamin B12 during Pregnancy with Newborn Birth Weight, Head Circumference, and Chest Circumference. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024; 43:452-463. [PMID: 38289269 DOI: 10.1080/27697061.2024.2307980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/16/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE This study evaluated the effect of an altered ratio of maternal RBC folate (MRF) to serum vitamin B12 (MB12) on pregnancy and newborn outcomes. METHODS Blood samples were collected from pregnant women and the umbilical cord at the time of delivery. Estimations of RBC folate and serum vitamin B12 from maternal and cord blood samples and total homocysteine (HCY) were performed. Maternal and newborn anthropometric parameters like placental weight (PW), head circumference (HC), chest circumference (CC), and body weight (BW) were measured in offsprings after birth. We stratified the pregnant women into six groups (a) vitamin B12 normal and folic acid normal (BNFN)-control group, (b) vitamin B12 normal and folic acid elevated (BNFE), (c) vitamin B12 normal and folic acid deficient (BNFD), (d) vitamin B12 deficient and folic acid normal (BDFN), (e) vitamin B12 deficient and folic acid elevated (BDFE) and (f) vitamin B12 deficient and folic acid deficient (BDFD) based on their levels of RBC folate (MRF) and vitamin B12 (MB12). The expression of the one-carbon metabolism genes (methionine synthase (MS), glycine N-methyltransferase (GNMT), and cystathionine β-synthase (CBS) was also studied in placental tissue by using real-time PCR. RESULTS Cord blood RBC folate was significantly reduced in groups BDFE and BDFD as compared to the control group (BNFN). The cord blood vitamin B12 levels were also reduced in the BDFE group as compared to the BDFD. All the newborn parameters viz. PW, HC, CC, and BW, were reduced in the altered MRF/MB12 ratio (low & high vs. normal ratio). Total HCY was significantly elevated in the groups with (BDFE & BDFN) an imbalance of maternal RBC folate and serum vitamin B12 as compared to the control group. Downregulation of one-carbon metabolism genes like MS (p < 0.001), GNMT (p < 0.05), and CBS (p < 0.01) in placental tissue was observed in the high MRF/MB12 ratio group as compared to the normal ratio group. A strong positive correlation was also observed between MRF, MB12, and newborn parameters. CONCLUSIONS The altered ratio of folate to vitamin B12 in the maternal blood is associated with adverse growth and development of the newborn.
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Affiliation(s)
- Ramji Rao Ramijinni
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aatish Mahajan
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divika Sapehia
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parampal Singh
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jyotdeep Kaur
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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You W, Donnelly F. A greater nurse and midwife density protects against infant mortality globally. J Pediatr Nurs 2024; 77:e158-e166. [PMID: 38614819 DOI: 10.1016/j.pedn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE As the largest profession within the health care workforce, nurses and midwives play a critical role in the health and wellness of families especially children and infants. This study suggests those countries with higher nurse and midwife densities (NMD) had lower infant mortality rates (IMR). DESIGN AND METHODS With affluence, low birthweight and urbanization incorporated as potential confounders, this ecological study analyzed the correlations between NMD and IMR with scatterplots, Pearson r correlation, partial correlation and multiple linear regression models. Countries were also grouped for analysing and comparing their Pearson's coefficients. RESULTS NMD inversely and significantly correlated to IMR worldwide. This relationship remained significant independent of the confounders, economic affluence, low birthweight and urbanization. Explaining 57.19% of IMR variance, high NMD was implicated in significantly reducing the IMR. PRACTICE IMPLICATIONS Countries with high NMD had lower IMRs both worldwide and with special regard to developing countries. This may interest healthcare policymakers, especially those from developing countries, to consider the impacts of global nursing and midwifery staffing shortages. Nurses and midwives are the group of healthcare professionals who spend most with infants and their carers. This may be another alert for the health authorities to extend nurses and midwives' practice scope for promoting infant health.
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Affiliation(s)
- Wenpeng You
- Adelaide Nursing School, the University of Adelaide, Adelaide, Australia; Acute and Urgent Care, Royal Adelaide Hospital, Adelaide, Australia; Adelaide Medical School, the University of Adelaide, Adelaide, Australia; School of Nursing and Midwifery, Western Sydney University, Sydney, Australia.
| | - Frank Donnelly
- Adelaide Nursing School, the University of Adelaide, Adelaide, Australia
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Tamir TT. Neonatal mortality rate and determinants among births of mothers at extreme ages of reproductive life in low and middle income countries. Sci Rep 2024; 14:12596. [PMID: 38824152 PMCID: PMC11144189 DOI: 10.1038/s41598-024-61867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/10/2024] [Indexed: 06/03/2024] Open
Abstract
Neonatal mortality, which refers to the death of neonates during the first 28 completed days of life, is a critical global public health concern. The neonatal period is widely recognized as one of the most precarious phases in human life. Research has indicated that maternal extreme ages during reproductive years significantly impact neonatal survival, particularly in low- and middle-income countries. Consequently, this study aims to evaluate the neonatal mortality rate and determinants among neonates born to mothers at extreme reproductive ages within these countries. A secondary analysis of demographic and health surveys conducted between 2015 and 2022 in 43 low- and middle-income countries was performed. The study included a total sample of 151,685 live births. Researchers utilized a multilevel mixed-effects model to identify determinants of neonatal mortality. The measures of association were evaluated using the adjusted odds ratio within a 95% confidence interval. The neonatal mortality rate among neonates born to mothers at extreme ages of reproductive life in low- and middle-income countries was 28.96 neonatal deaths per 1000 live births (95% CI 28.13-29.82). Factors associated with higher rates of neonatal mortality include male gender, low and high birth weight, maternal education (no or low), home deliveries, multiple births, short preceding birth intervals, lack of postnatal checkups, and countries with high fertility and low literacy rates. This study sheds light on the neonatal mortality rates among neonates born to mothers at extreme ages of reproductive life in low- and middle-income countries. Notably, we found that neonatal mortality was significantly higher in this group compared to neonatal mortality rates reported regardless of maternal ages. Male babies, low and high birth-weighted babies, those born to mothers with no or low education, delivered at home, singletons, babies born with a small preceding birth interval, and those without postnatal checkups faced elevated risks of neonatal mortality. Additionally, neonates born in countries with high fertility and low literacy rates were also vulnerable. These findings underscore the urgent need for targeted interventions tailored to mothers at extreme ages. Policymakers and healthcare providers should prioritize strategies that address specific risk factors prevalent in these vulnerable populations. By doing so, we can improve neonatal outcomes and ensure the survival of these newborns during the critical neonatal period.
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Affiliation(s)
- Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Van Pee T, Martens DS, Alfano R, Engelen L, Sleurs H, Rasking L, Plusquin M, Nawrot TS. Cord Blood Proteomic Profiles, Birth Weight, and Early Life Growth Trajectories. JAMA Netw Open 2024; 7:e2411246. [PMID: 38743419 PMCID: PMC11094560 DOI: 10.1001/jamanetworkopen.2024.11246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/13/2024] [Indexed: 05/16/2024] Open
Abstract
Importance The cord blood proteome, a repository of proteins derived from both mother and fetus, might offer valuable insights into the physiological and pathological state of the fetus. However, its association with birth weight and growth trajectories early in life remains unexplored. Objective To identify cord blood proteins associated with birth weight and the birth weight ratio (BWR) and to evaluate the associations of these cord blood proteins with early growth trajectories. Design, Setting, and Participants This cohort study included 288 mother-child pairs from the ongoing prospective Environmental Influence on Early Aging birth cohort study. Newborns were recruited from East-Limburg Hospital in Genk, Belgium, between February 2010 and November 2017 and followed up until ages 4 to 6 years. Data were analyzed from February 2022 to September 2023. Main Outcomes and Measures The outcome of interest was the associations of 368 inflammatory-related cord blood proteins with birth weight or BWR and with early life growth trajectories (ie, rapid growth at age 12 months and weight, body mass index [BMI] z score, waist circumference, and overweight at age 4-6 years) using multiple linear regression models. The BWR was calculated by dividing the birth weight by the median birth weight of the population-specific reference growth curve, considering parity, sex, and gestational age. Results are presented as estimates or odds ratios (ORs) for each doubling in proteins. Results The sample included 288 infants (125 [43.4%] male; mean [SD] gestation age, 277.2 [11.6] days). The mean (SD) age of the child at the follow-up examination was 4.6 (0.4) years old. After multiple testing correction, there were significant associations of birth weight and BWR with 7 proteins: 2 positive associations: afamin (birth weight: coefficient, 341.16 [95% CI, 192.76 to 489.50]) and secreted frizzled-related protein 4 (SFRP4; birth weight: coefficient, 242.60 [95% CI, 142.77 to 342.43]; BWR: coefficient, 0.07 [95% CI, 0.04 to 0.10]) and 5 negative associations: cadherin EGF LAG 7-pass G-type receptor 2 (CELSR2; birth weight: coefficient, -237.52 [95% CI, -343.15 to -131.89]), ephrin type-A receptor 4 (EPHA4; birth weight: coefficient, -342.78 [95% CI, -463.10 to -222.47]; BWR: coefficient, -0.11 [95% CI, -0.14 to -0.07]), SLIT and NTRK-like protein 1 (SLITRK1; birth weight: coefficient, -366.32 [95% CI, -476.66 to -255.97]; BWR: coefficient, -0.11 [95% CI, -0.15 to -0.08]), transcobalamin-1 (TCN1; birth weight: coefficient, -208.75 [95% CI, -305.23 to -112.26]), and unc-5 netrin receptor D (UNC5D; birth weight: coefficient, -209.27 [95% CI, -295.14 to -123.40]; BWR: coefficient, -0.07 [95% CI, -0.09 to -0.04]). Further evaluation showed that 2 proteins were still associated with rapid growth at age 12 months (afamin: OR, 0.32 [95% CI, 0.11-0.88]; TCN1: OR, 2.44 [95% CI, 1.26-4.80]). At age 4 to 6 years, CELSR2, EPHA4, SLITRK1, and UNC5D were negatively associated with weight (coefficients, -1.33 to -0.68 kg) and body mass index z score (coefficients, -0.41 to -0.23), and EPHA4, SLITRK1, and UNC5D were negatively associated with waist circumference (coefficients, -1.98 to -0.87 cm). At ages 4 to 6 years, afamin (OR, 0.19 [95% CI, 0.05-0.70]) and SLITRK1 (OR, 0.32 [95% CI, 0.10-0.99]) were associated with lower odds for overweight. Conclusions and Relevance This cohort study found 7 cord blood proteins associated with birth weight and growth trajectories early in life. Overall, these findings suggest that stressors that could affect the cord blood proteome during pregnancy might have long-lasting associations with weight and body anthropometrics.
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Affiliation(s)
- Thessa Van Pee
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Dries S. Martens
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Rossella Alfano
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Liesa Engelen
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Hanne Sleurs
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Leen Rasking
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tim S. Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Public Health and Primary Care, Leuven University, Leuven, Belgium
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Pouget ER, Feyissa GT, Wong T. Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential Indicator of Structural Anti-Black Racism. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01984-4. [PMID: 38528178 DOI: 10.1007/s40615-024-01984-4] [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: 12/12/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Structural racism accounts for inequity in health outcomes in ways that are difficult to measure. To conduct more actionable research and measure the impact of intervention programs, there is a need to develop indicator measures of structural racism. One potential candidate is the Adult Sex Ratio (ASR), which was identified by Du Bois as an important indicator of social life functioning over 100 years ago and has remained significant up to the present day. This study investigated the utility of this measure. METHODS We compared birth/infant health outcomes using the US 2000 Linked Birth/Infant Death Cohort Data Set matched with 2000 Census data on adult sex ratios in multilevel logistic regression models, stratified by the racial/ethnic category of the mothers. RESULTS In an adjusted model, the odds of infant death was 21% higher among non-Hispanic Black (NHB) women living in counties in the lowest ASR tertile category when compared to their counterparts in counties in the highest ASR tertile. Similarly, the odds of giving birth to a preterm or a low birth weight infant were each 20% higher among NHB women living in counties in the lowest ASR tertile compared to their counterparts in counties in the highest ASR tertile. CONCLUSION ASRs may serve as a useful indicator of anti-Black structural racism at the local level. More research is needed to determine the circumstances under which this factor may serve to improve assessment of structural racism and facilitate health equity research.
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Affiliation(s)
- Enrique R Pouget
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA.
| | - Garumma T Feyissa
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA
| | - Tracy Wong
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA
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Jeong KJ, Mukae M, Lee SR, Kim SY, Kim SH, Cho YE, An BS, Ko JW, Kwun HJ, Baek IJ, Hong EJ. Progesterone increases hepatic lipid content and plasma lipid levels through PR- B-mediated lipogenesis. Biomed Pharmacother 2024; 172:116281. [PMID: 38364736 DOI: 10.1016/j.biopha.2024.116281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/04/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
Progesterone (P4) is a crucial reproductive hormone that acts as a precursor for all other endogenous steroids. P4 modulates transcriptional activity during reproduction by binding to progesterone receptors (PR). However, the physiological role of P4 in the liver is understudied. P4-mediated lipid metabolism in the liver was investigated in this study, as P4 facilitates insulin resistance and influences energy metabolism. While exogenous lipids are mainly obtained from food, the liver synthesizes endogenous triglycerides and cholesterol from a carbohydrate diet. Hepatic de novo lipogenesis (DNL) is primarily determined by acetyl-CoA and its biosynthetic pathways, which involve fatty acid and cholesterol synthesis. While P4 increased the hepatic levels of sterol regulatory element-binding protein 1 C (SREBP-1 C), peroxisome proliferator-activated receptor-gamma (PPARγ), acetyl-CoA carboxylase (ACC), and CD36, co-treatment with the P4 receptor antagonist RU486 blocked these proteins and P4-mediated lipogenesis. RNA sequencing was used to assess the role of P4 in lipogenic events, such as fatty liver and fatty acid metabolism, lipoprotein signaling, and cholesterol metabolism. P4 induced hepatic DNL and lipid anabolism were confirmed in the liver of ovarian resection mice fed a high-fat diet or in pregnant mice. P4 increased lipogenesis directly in mice exposed to P4 and indirectly in fetuses exposed to maternal P4. The lipid balance between lipogenesis and lipolysis determines fat build-up and is linked to lipid metabolism dysfunction, which involves the breakdown and storage of fats for energy and the synthesis of structural and functional lipids. Therefore, P4 may impact the lipid metabolism and reproductive development during gestation.
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Affiliation(s)
- Kang Ju Jeong
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Moeka Mukae
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Sang R Lee
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Sang-Yun Kim
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon 34114, Republic of Korea
| | - Seong Hyeon Kim
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea; Reproductive Toxicology Research Group, Korea Institute of Toxicology, Daejeon 34114, Republic of Korea
| | - Young-Eun Cho
- Department of Food and Nutrition, Andong National University, Andong, Korea
| | - Beum-Soo An
- Department of Biomaterials Science, College of Natural Resources & Life Science, Pusan National University, Miryang 50463, Republic of Korea
| | - Je-Won Ko
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Hyo-Jung Kwun
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - In-Jeoung Baek
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Eui-Ju Hong
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea.
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Nnagbo JE, Ugwu GO, Eze MI, Agu PU, Nnagbo CL, Udealor PC, Ezugwu EC, Ugwu EO, Nwagha IU, Ezegwui HU. Incidence, Determinants, and Outcomes of Spontaneous Preterm Birth at Tertiary Hospitals in Enugu, Southeast, Nigeria: A Cross-Sectional Study. Niger J Clin Pract 2024; 27:228-235. [PMID: 38409152 DOI: 10.4103/njcp.njcp_634_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/06/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND In the past five years, observational evidence suggests that the rates and determinants of preterm birth may have changed due to the effect of the coronavirus disease 2019 (COVID-19) pandemic and other humanitarian crises in our environment. AIM This study aimed to determine the incidence, associated factors, and outcomes of preterm birth in tertiary hospitals in Enugu, southeastern Nigeria. METHODS This cross-sectional study included 238 pregnant women from the University of Nigeria Teaching Hospital (UNTH), Enugu State University of Science and Technology Teaching Hospital (ESUT-TH) Parklane, and Mother of Christ Specialist Hospital (MOCSH), Enugu, from April 2022 to March 2023. Eligible and consenting participants were recruited from 28-36 weeks +6 days of gestational age and followed up until delivery. Relevant outcome variables, such as sociodemographic characteristics, gestational age at delivery, and pregnancy outcomes, were recorded in a pro forma. These data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) statistics for Windows, version 22.0, Armonk, NY: IBM Corp. RESULTS The incidence of preterm birth was 16.6% (37/223), with spontaneous preterm birth constituting 24 of 37 (64.5%) cases. The mean age of participants was 30.3 ± 4.8 years. Advanced maternal age (>35 years) (P = 0.01, adjusted odds ratio (AOR) =0.01, confidence interval (CI): 0.00-0.144), low socioeconomic status (P = 0.04, AOR = 0.40, CI: 0.11-1.46), and history of miscarriage (P = 0.02, AOR = 0.06, CI: 0.01-0.59) were the factors associated with spontaneous preterm birth. Neonatal death occurred in 21.6% (8/37) of cases within the first 24 hours. Rates of cesarean section and low birth weight were 73% (27/37) each. CONCLUSIONS The incidence of preterm birth is high in Enugu, and associated factors were advanced maternal age, low socioeconomic status, and a history of miscarriage.
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Affiliation(s)
- J E Nnagbo
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - G O Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - M I Eze
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - P U Agu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - C L Nnagbo
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - P C Udealor
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - E C Ezugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - E O Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - I U Nwagha
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - H U Ezegwui
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Donzelli G, Marcos-Puig B, Peraita-Costa I, Llopis-Morales J, Morales-Suarez-Varela M. Occupational Exposure during Pregnancy and Effects on Newborns: A Nested Case-Control Study. Life (Basel) 2023; 13:1962. [PMID: 37895344 PMCID: PMC10608645 DOI: 10.3390/life13101962] [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: 08/14/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The protection of pregnant workers should be based on evidence regarding the risks to reproductive health from exposure to specific work environments and conditions. The objective of this study was to identify the effects on mothers and newborns resulting from environmental exposure to various occupational risks. METHODS The study cohort was composed of 399 women admitted to the Obstetrics/Postpartum ward at Hospital La Fe in Valencia, Spain. Face-to-face interviews were conducted to establish associations between workplace exposure during pregnancy and its effects on maternal and newborn health. Sex, anthropometric characteristics, and blood gas analysis in arterial and venous umbilical cord blood at delivery were collected. RESULTS A total of 138 women were exposed to biological and/or chemical risks, 122 to physical risks, and 139 at no risk of exposure. In the group with chemical and/or biological risks, the frequency of women who resorted to in vitro fertilization to achieve the studied pregnancy is less than half of the group exposed to physical risks, with statistically significant differences (p = 0.047). The mean values for the arterial analysis in both exposure groups were within average values, with similar pH values between them, but the mean values of PCO2 and PO2 were lower in the group of neonates of mothers exposed to physical risks, with a significant difference for arterial PO2 (p = 0.027). CONCLUSION Our analysis contributes evidence for planning and prioritizing preventive actions to protect women's reproductive health. The results suggest the continuation of a future project that would consider more factors and potentially increase the sample size.
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Affiliation(s)
- Gabriele Donzelli
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), 56124 Pisa, Italy;
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Beatriz Marcos-Puig
- Department of Gynecology and Obstetrics, La Fé University and Polytechnic Hospital, Avda. Fernando Abril Martorell 106, 46026 Valencia, Spain;
| | - Isabel Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, Burjassot, 46100 Valencia, Spain;
- Biomedical Research Center in Epidemiology and Public Health Network (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Spain
| | - Juan Llopis-Morales
- Faculty of Pharmacy, Universidad Alfonso X el Sabio, Avda. de la Universidad 1, Villanueva de la Cañada, 28691 Madrid, Spain;
| | - María Morales-Suarez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, Burjassot, 46100 Valencia, Spain;
- Biomedical Research Center in Epidemiology and Public Health Network (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Spain
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Jana A, Dey D, Ghosh R. Contribution of low birth weight to childhood undernutrition in India: evidence from the national family health survey 2019-2021. BMC Public Health 2023; 23:1336. [PMID: 37438769 DOI: 10.1186/s12889-023-16160-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Infants born with low birth weight (LBW), i.e. less than 2500g, is considered an important factor of malnutrition in Asia. In India, research related to this issue is still neglected and limited. Evidence exists that a large number of child deaths occur in India due to maternal and child malnutrition-related complications. Moreover, it has been found that the cost of malnutrition in India results in a significant reduction of the country's Gross Domestic Product (GDP). Thus, in this current context, this study aims to explore the contribution of low birth weight to childhood undernutrition in India. METHODS The study used data from the 5th round of the National Family Health Survey (NFHS-5), a large-scale survey conducted in India. The survey collected information from 176,843 mothers and 232,920 children. The study used the last birth information (last children born 5 years preceding the survey) due to the detailed availability of maternal care information. Univariate and bivariate analyses were conducted to determine the percentage distribution of outcome variables. Multivariate logistic regression was employed to examine the association between LBW and undernutrition (stunting, wasting, and underweight). The study also used the Fairlie decomposition analysis to estimate the contribution of LBW to undernutrition among Indian children. RESULTS The results show that childhood undernutrition was higher in states like Uttar Pradesh, Bihar, Jharkhand, Gujarat, and Maharashtra. The results of the logistic regression analysis show that infants born with low birth weight were more likely to be stunted (OR = 1.46; 95% CI: 1.41-1.50), wasted (OR = 1.33; 95% CI: 1.27-1.37), and underweight (OR = 1.76; 95% CI: 1.70-1.82) in their childhood compared to infants born without low birth weight. The findings from the decomposition analysis explained that approximately 14.8% of the difference in stunting, 10.4% in wasting, and 9.6% in underweight among children born with low birth weight after controlling for the individuals' selected characteristics. CONCLUSION The findings suggest that LBW has a significant contribution to malnutrition. The study suggests that policymakers should prioritize strengthening maternal and child healthcare schemes, particularly focusing on antenatal and postnatal care, as well as kangaroo mother care at the grassroots level to reduce the burden of LBW and undernourished children.
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Affiliation(s)
- Arup Jana
- Research Scholar, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Deepshikha Dey
- MPhil., International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Ranjita Ghosh
- PhD Scholar, Institute for Social and Economic Change, Karnataka, 560072, India.
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Manghat S, Kar S, Bethou A, Sarkar S. Impact of Low Birth Weight on the Prevalence and Economic Burden of Common Childhood Illnesses Among Under-Five Children in India: Findings From Nationally Representative Surveys. Cureus 2023; 15:e41507. [PMID: 37551227 PMCID: PMC10404387 DOI: 10.7759/cureus.41507] [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] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Background Common childhood illnesses such as diarrhea, fever, and acute respiratory infection impose substantial health burdens among under-five children, and Low Birth Weight (LBW) has been associated with an increased prevalence of these illnesses. However, the impact of LBW on healthcare utilization and the economic burden of these illnesses remains understudied. Aim To assess the impact of LBW on the prevalence, healthcare utilization, and Out of Pocket Expenditure (OOPE) for outpatient (OP) treatment of selected Common Childhood Illnesses (CCHI) among under-five children in India. Methodology This study utilized data from two nationally representative surveys conducted in India; National Family Health Survey (NFHS-5) (2019-2021) and the National Sample Survey Organization (NSSO) 75th Round Schedule Social Consumption: Health (2017-2018). Data from the NFHS-5 was analyzed to assess the impact of LBW on the prevalence of selected CCHI and healthcare utilization. Comparison of OOPE for OP treatment of selected CCHI between LBW and Normal Birth Weight (NBW) children done using the median OOPE for OP visits of CCHI estimated from the NSSO data. Results The two-week prevalence of selected CCHI among LBW and NBW children was found to be 20.0% (95% CI 19.6 -20.4) and 18.0% (95% CI 17.8 -18.2), respectively. There was no significant difference between LBW and NBW children on healthcare utilization for the treatment of CCHI; both groups had a similar proportion (around 70%) of formal medical treatment utilization for CCHI. The median OOPE spending for OP visits per episode of CCHI was comparable between LBW and NBW children. However, families of LBW children had higher annual OOPE spending for OP visits related to CCHI, with projected estimates of INR 1,446 ($19.56) for LBW children and INR 1,271 ($17.2) for NBW children. Conclusion LBW was associated with a higher prevalence of CCHI. Even though healthcare utilization was similar among LBW and NBW children, a higher prevalence of CCHI among LBW children led to higher OOPE. LBW children have approximately 13% higher annual OOPE spending for the OP visits related to selected CCHI compared to NBW children.
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Affiliation(s)
- Sreeja Manghat
- Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sitanshu Kar
- Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Adhisivam Bethou
- Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Sonali Sarkar
- Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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