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Jiang H, Meng T, Li Z. Role of circular RNAs in preeclampsia (Review). Exp Ther Med 2024; 28:372. [PMID: 39091629 PMCID: PMC11292168 DOI: 10.3892/etm.2024.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 06/25/2024] [Indexed: 08/04/2024] Open
Abstract
Preeclampsia (PE) is a hypertensive disorder of pregnancy characterized by new-onset hypertension and proteinuria after 20 weeks of gestation, which affects 3-8% of pregnant individuals worldwide each year. Prevention, diagnosis and treatment of PE are some of the most important problems faced by obstetrics. There is growing evidence that circular RNAs (circRNAs) are involved in the pathogenesis of PE. The present review summarizes the research progress of circRNAs and then describes the expression patterns of circRNAs in PE and their functional mechanisms affecting PE development. The role of circRNAs as biomarkers for the diagnosis of PE, and the research status of circRNAs in PE are summarized in the hope of finding novel strategies for the prevention and treatment of PE.
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Affiliation(s)
- Hengxue Jiang
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
- Department of Obstetrics and Gynecology, China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Tao Meng
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Ziwei Li
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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2
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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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Callbo PN, Junus K, Gabrysch K, Bergman L, Poromaa IS, Lager S, Wikström AK. Novel Associations Between Mid-Pregnancy Cardiovascular Biomarkers and Preeclampsia: An Explorative Nested Case-Control Study. Reprod Sci 2024; 31:1391-1400. [PMID: 38253981 DOI: 10.1007/s43032-023-01445-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
Prediction of women at high risk of preeclampsia is important for prevention and increased surveillance of the disease. Current prediction models need improvement, particularly with regard to late-onset preeclampsia. Preeclampsia shares pathophysiological entities with cardiovascular disease; thus, cardiovascular biomarkers may contribute to improving prediction models. In this nested case-control study, we explored the predictive importance of mid-pregnancy cardiovascular biomarkers for subsequent preeclampsia. We included healthy women with singleton pregnancies who had donated blood in mid-pregnancy (~ 18 weeks' gestation). Cases were women with subsequent preeclampsia (n = 296, 10% of whom had early-onset preeclampsia [< 34 weeks]). Controls were women who had healthy pregnancies (n = 333). We collected data on maternal, pregnancy, and infant characteristics from medical records. We used the Olink cardiovascular II panel immunoassay to measure 92 biomarkers in the mid-pregnancy plasma samples. The Boruta algorithm was used to determine the predictive importance of the investigated biomarkers and first-trimester pregnancy characteristics for the development of preeclampsia. The following biomarkers had confirmed associations with early-onset preeclampsia (in descending order of importance): placental growth factor (PlGF), matrix metalloproteinase (MMP-12), lectin-like oxidized LDL receptor 1, carcinoembryonic antigen-related cell adhesion molecule 8, serine protease 27, pro-interleukin-16, and poly (ADP-ribose) polymerase 1. The biomarkers that were associated with late-onset preeclampsia were BNP, MMP-12, alpha-L-iduronidase (IDUA), PlGF, low-affinity immunoglobulin gamma Fc region receptor II-b, and T cell surface glycoprotein. Our results suggest that MMP-12 is a promising novel preeclampsia biomarker. Moreover, BNP and IDUA may be of value in enhancing prediction of late-onset preeclampsia.
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Affiliation(s)
- Paliz Nordlöf Callbo
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE 751 85, Uppsala, Sweden.
| | - Katja Junus
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE 751 85, Uppsala, Sweden
| | | | - Lina Bergman
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE 751 85, Uppsala, Sweden
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Inger Sundström Poromaa
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE 751 85, Uppsala, Sweden
| | - Susanne Lager
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE 751 85, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE 751 85, Uppsala, Sweden
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Temel M, Durmuş M, Durmaz ŞE, Güvenir D, Gürkaş E. Posterior Reversible Encephalopathy Syndrome in Eclamptic Patients: The Relationship between Blood Pressure, Cranial Involvement, and Seizure Recurrence. Gynecol Obstet Invest 2024; 89:330-334. [PMID: 38527423 DOI: 10.1159/000538519] [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: 09/04/2023] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES Posterior reversible encephalopathy syndrome (PRES) is a clinic radiological disorder characterized by headache, epileptic seizure, encephalopathy, visual impairment, and focal neurological deficits. Gestational hypertension, which is a significant risk factor for PRES, may cause significant morbidity and mortality among pregnant women. DESIGN Twenty-four patients with PRES caused by eclampsia who were admitted to our hospital in the last 5 years were included in this study. PARTICIPANTS/MATERIALS, SETTING, METHODS Blood pressure at admission, the number of regions with vasogenic edema in the brain, and recurrent seizures were noted. Patients were divided into three groups: mild, moderate, and severe. RESULTS Using Kruskal-Wallis and Pearson χ2 tests, there was no statistical significance between the groups in terms of cranial involvement (p = 0.471). However, binary logistic regression analysis showed that seizure recurrence increased in correlation with blood pressure (p = 0.04). LIMITATIONS PRES is a rare syndrome associated with several etiologies. In our study, only patients with PRES due to eclampsia were included. Therefore, the number of included patients was limited (24 participants). CONCLUSION PRES may occur in eclamptic patients with mild, moderate, or severe blood pressure values. Evaluation by magnetic resonance imaging is needed to confirm the diagnosis. Early and rapid treatment is essential for reducing morbidity and mortality among pregnant women.
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Affiliation(s)
- Musa Temel
- Neurology, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Merve Durmuş
- Obstetric and Gynecology, Ozel Ege Yasam Hospital, Izmir, Turkey
| | | | - Deniz Güvenir
- Radiology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Erdem Gürkaş
- Neurology, Kartal Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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Kovacheva VP, Eberhard BW, Cohen RY, Maher M, Saxena R, Gray KJ. Preeclampsia Prediction Using Machine Learning and Polygenic Risk Scores From Clinical and Genetic Risk Factors in Early and Late Pregnancies. Hypertension 2024; 81:264-272. [PMID: 37901968 PMCID: PMC10842389 DOI: 10.1161/hypertensionaha.123.21053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Preeclampsia, a pregnancy-specific condition associated with new-onset hypertension after 20-weeks gestation, is a leading cause of maternal and neonatal morbidity and mortality. Predictive tools to understand which individuals are most at risk are needed. METHODS We identified a cohort of N=1125 pregnant individuals who delivered between May 2015 and May 2022 at Mass General Brigham Hospitals with available electronic health record data and linked genetic data. Using clinical electronic health record data and systolic blood pressure polygenic risk scores derived from a large genome-wide association study, we developed machine learning (XGBoost) and logistic regression models to predict preeclampsia risk. RESULTS Pregnant individuals with a systolic blood pressure polygenic risk score in the top quartile had higher blood pressures throughout pregnancy compared with patients within the lowest quartile systolic blood pressure polygenic risk score. In the first trimester, the most predictive model was XGBoost, with an area under the curve of 0.74. In late pregnancy, with data obtained up to the delivery admission, the best-performing model was XGBoost using clinical variables, which achieved an area under the curve of 0.91. Adding the systolic blood pressure polygenic risk score to the models did not improve the performance significantly based on De Long test comparing the area under the curve of models with and without the polygenic score. CONCLUSIONS Integrating clinical factors into predictive models can inform personalized preeclampsia risk and achieve higher predictive power than the current practice. In the future, personalized tools can be implemented to identify high-risk patients for preventative therapies and timely intervention to improve adverse maternal and neonatal outcomes.
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Affiliation(s)
- Vesela P Kovacheva
- Department of Anesthesiology, Perioperative and Pain Medicine (V.P.K., B.W.E., R.Y.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Braden W Eberhard
- Department of Anesthesiology, Perioperative and Pain Medicine (V.P.K., B.W.E., R.Y.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raphael Y Cohen
- Department of Anesthesiology, Perioperative and Pain Medicine (V.P.K., B.W.E., R.Y.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- PathAI, Boston, MA (R.Y.C.)
| | - Matthew Maher
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Genomic Medicine, Massachusetts General Hospital, Boston (M.M., R.S., K.J.G.)
| | - Richa Saxena
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Genomic Medicine, Massachusetts General Hospital, Boston (M.M., R.S., K.J.G.)
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (R.S.)
| | - Kathryn J Gray
- Division of Maternal-Fetal Medicine (K.J.G.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Anesthesia, Critical Care and Pain Medicine, Center for Genomic Medicine, Massachusetts General Hospital, Boston (M.M., R.S., K.J.G.)
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Kea AZ, Lindtjørn B, Tekle AG, Hinderaker SG. Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002466. [PMID: 38150438 PMCID: PMC10752526 DOI: 10.1371/journal.pgph.0002466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/15/2023] [Indexed: 12/29/2023]
Abstract
Studies examining skilled birth attendants (SBA) use and its correlation with maternal mortality at lower administrative levels are scarce. This study assessed the coverage and variations of SBA, the physical accessibility of health facilities for SBA, and the association of SBA with maternal mortality. A cross-sectional study using a population-based household survey was conducted in six Sidama National Regional State, southern Ethiopia districts, from July 2019 to May 2020. Women who had given birth in the past two years before the study were included. Stata 15 and ArcGIS 10.4.1 were used for data analysis. A multilevel logistic regression analysis was conducted to assess the effect of the sampling units and identify factors independently associated with SBA. The association between SBA and maternal mortality was examined using maternal mortality household survey data. A total of 3191 women who had given birth in the past two years and resided in 8880 households sampled for the associated maternal mortality household survey were interviewed. The coverage of SBA was 46.7%, with high variations in the districts. Thirty percent of SBA use was accounted for by the differences among the districts. One-third of the women travel more than two hours on foot to access the nearest hospital. Districts with low coverage of SBA and located far away from the regional referral centre had high maternal mortality. Education of the mother, occupation of the husband, pregnancy-related complications, use of antenatal care, parity, and distance to the nearest hospital and health centre were associated with the use of SBA. The coverage of SBA in the Sidama Region was low, with high variations in the districts. Low SBA use was associated with high maternal mortality. Due attention should be given to districts with low coverage of SBA and those located far away from the referral centre. Access to hospitals has to improve. All women should be encouraged to get antenatal care services.
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Affiliation(s)
- Aschenaki Zerihun Kea
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Bernt Lindtjørn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
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Liu W, Zhang T, Wang J, Zhao G, Hou Y. Protective Effect of Akkermansia muciniphila on the Preeclampsia-Like Mouse Model. Reprod Sci 2023; 30:2623-2633. [PMID: 36920671 DOI: 10.1007/s43032-023-01206-y] [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: 11/07/2022] [Accepted: 02/26/2023] [Indexed: 03/16/2023]
Abstract
Preeclampsia (PE) is known as a metabolism-related complication of pregnancy related to gut dysbiosis including the decreased abundance of Akkermansia muciniphila (A. muciniphila). However, the modulatory role of A. muciniphila as a supplement for PE remains ambiguous. This study investigated the effect of A. muciniphila administration on PE-like mice and its underlying mechanisms. A total of twenty-four C57BL/6 mice were randomly assigned into three groups. PE-like symptoms were induced by continuous injection of L-NAME intraperitoneally from gestational day (GD) 11 to GD18 combined with oral administration of pasteurized A. muciniphila during GD14-18 or not. Mice were sacrificed at GD19 to collect for further evaluation. Decreased A. muciniphila was observed in a successfully established PE-like model than normotensive pregnant control (NP), inversely correlated to increased systolic blood pressure blood and 24-h proteinuria. After supplementing with A. muciniphila, mice showed significantly minimized blood pressure and protein expression in urine, increased number of pups and weight of both embryos and placentas. In addition, colonies of bacteria, inflammatory cytokines (TNF-α and IL-6), and metabolic products of lipids including TC, FC, and TG were alleviated by A. muciniphila in the placentas. Among proteins linked with bowel barrier functions, diminished 2-AG and growing ZO-1 and occludin were attributable to A. muciniphila. Also, enhanced Treg/Th17 ratios were found in the intestines of mice treated with A. muciniphila. A. muciniphila facilitated alleviating PE-like symptoms and was beneficial as a novel probiotic therapeutic agent for PE.
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Affiliation(s)
- Wei Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xincheng District, Xi'an, 710004, Shaanxi, China.
| | - Tingting Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xincheng District, Xi'an, 710004, Shaanxi, China
| | - Juanni Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xincheng District, Xi'an, 710004, Shaanxi, China
| | - Gang Zhao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xincheng District, Xi'an, 710004, Shaanxi, China
| | - Yuemin Hou
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xincheng District, Xi'an, 710004, Shaanxi, China
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Belfort GP, de Padilha PC, Farias DR, da Silva LBG, dos Santos K, Gomes EDS, Lima TSV, Bornia RBRG, Rezende KBC, Saunders C. Effect of the Dietary Approaches to Stop Hypertension (DASH) diet on the development of preeclampsia and metabolic outcomes in pregnant women with pre-existing diabetes mellitus: a randomised, controlled, single-blind trial. J Nutr Sci 2023; 12:e73. [PMID: 37457679 PMCID: PMC10345782 DOI: 10.1017/jns.2023.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Preeclampsia (PE) affects up to five times more women with pre-existing diabetes mellitus (PDM) than women without it. The present study aimed to identify the effect of the DASH diet on PE incidence (primary outcome) and blood pressure, glycated haemoglobin (GH), serum lipids, glutathione peroxidase (GP), C-reactive protein (CRP - secondary outcomes) in pregnant with PDM. This randomised, controlled, single-blind trial studied sixty-eight pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital, Brazil. The standard diet group (SDG) received a diet containing 45-65 % carbohydrates, 15-20 % protein and 25-30 % lipids. The DASH diet group (DDG) received the adapted DASH diet with a similar macronutrient distribution, but with a higher concentration of fibres, unsaturated fats, calcium, magnesium and potassium as well as lower saturated fat. Student's t, Mann-Whitney U and the Chi-square tests were used to compare outcomes. PE incidence was 22⋅9 % in the SDG and 12⋅1 % in the DDG (P = 0⋅25). GP levels significantly increased in the DDG (intra-group analysis; mean difference = 1588 [CI 181, 2994], P = 0⋅03) and tended to be different from the variation in the SDG (mean difference = -29⋅5 [CI -1305; 1⋅365]; v. DDG: 1588 [CI 181; 2994], P = 0⋅09). GH levels decreased significantly and similarly between groups (SDG: -0⋅61 [CI -0⋅26, -0⋅96], P = 0⋅00) v. DDG: -1⋅1 [CI -0⋅57, -1⋅62], P = 0⋅00). There was no evidence of a difference in PE incidence at the end of the intervention between the two diets. The DASH diet seems to favour PE-related biochemical markers.
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Affiliation(s)
- Gabriella P. Belfort
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
- Applied Nutrition Department, Federal University of the State of Rio de Janeiro, 296, Pasteur Ave, Rio de Janeiro, RJ 22290-240, Brazil
| | - Patricia C. de Padilha
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Dayana R. Farias
- Social and Applied Nutrition Department, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Letícia B. G. da Silva
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Karina dos Santos
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
- Public Health Nutrition Department, Federal University of the State of Rio de Janeiro, 296, Pasteur Ave, Rio de Janeiro, RJ 22290-240, Brazil
| | - Erlaine de S. Gomes
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Thaissa S. V. Lima
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
| | - Rita Bernardete R. G. Bornia
- Maternity School of the Federal University of Rio de Janeiro, 180 Laranjeiras St, Rio de Janeiro, RJ, 22240-003, Brazil
| | - Karina B. C. Rezende
- Maternity School of the Federal University of Rio de Janeiro, 180 Laranjeiras St, Rio de Janeiro, RJ, 22240-003, Brazil
| | - Claudia Saunders
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, 373, Carlos Chagas Filho Ave, University City, Rio de Janeiro, RJ 21941-590, Brazil
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Torre Monmany N, Astete JA, Ramaiah D, Suchitra J, Krauel X, Fillol M, Balasubbaiah Y, Alarcón A, Bassat Q. Extended Perinatal Mortality Audit in a Rural Hospital in India. Am J Perinatol 2023; 40:375-386. [PMID: 33902133 DOI: 10.1055/s-0041-1727220] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study is to describe the status of perinatal mortality (PM) in an Indian rural hospital. STUDY DESIGN Retrospective analysis of data was compiled from PM meetings (April 2017 to December 2018) following "Making Every Baby Count: audit and review of stillbirths and neonatal deaths (ENAP or Every Newborn Action Plan)." RESULTS The study includes 8,801 livebirths, 105 stillbirths (SBs); 74 antepartum stillbirths [ASBs], 22 intrapartum stillbirths [ISBs], and nine unknown timing stillbirths [USBs]), 39 neonatal deaths or NDs (perinatal death or PDs 144). The higher risks for ASBs were maternal age >34 years, previous history of death, and/or SBs. Almost half of the PDs could be related with antepartum complications. More than half of the ASB were related with preeclampsia/eclampsia and abruptio placentae; one-third of the ISB were related with preeclampsia/eclampsia and gestational hypertension, fetal growth restriction, and placental dysfunction. The main maternal conditions differed between PDs (p = 0.005). The main causes of the ND were infections, congenital malformations, complications of prematurity, intrapartum complications, and unknown. The stillbirth rate was 11.8/1,000 births, neonatal mortality rate 4.4/1,000 livebirths, and perinatal mortality rate 15.8/1,000 births. CONCLUSION This is the first study of its kind in Andhra Pradesh being the first step for the analysis and prevention of PM. KEY POINTS · Many conditions that lead to stillbirths are linked to neonatal deaths and PM has been outside of the global parameters from the last decades.. · This is the first study following International Classification of Disease perinatal mortality codes and the audit of ENAP in Andhra Pradesh.. · Extended PM and mortality are mainly caused by similar preventable and treatable conditions..
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Affiliation(s)
- Núria Torre Monmany
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Paediatric Emergency Transport, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Joaquín Américo Astete
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Paediatrics, Pediatria dels pirineus, la Seu d'Urgell, Spain
| | - Dasarath Ramaiah
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
| | - Jyothi Suchitra
- Department of Gynecology and Obstetrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
| | - Xavier Krauel
- Department of Paediatrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Neonatology, Sant Joan de déu Hospital, Barcelona, Spain
| | - Manolo Fillol
- Department of Gynecology and Obstetrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
- Department of Gynecology, Hospital de la plana, Castellón, Spain
| | - Yadamala Balasubbaiah
- Department of Gynecology and Obstetrics, Rural Development Trust Children's Hospital, Bathalapalli, Andhra Pradesh, India
| | - Ana Alarcón
- Department of Neonatology, Sant Joan de déu Hospital, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Icrea, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Bokström-Rees E, Zetterberg H, Blennow K, Hastie R, Schell S, Cluver C, Bergman L. Correlation between cognitive assessment scores and circulating cerebral biomarkers in women with pre-eclampsia and eclampsia. Pregnancy Hypertens 2023; 31:38-45. [PMID: 36549047 DOI: 10.1016/j.preghy.2022.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The cerebral injury biomarkers neurofilament light chain (NfL) and tau and the glial activation biomarker glial fibrillary acidic protein (GFAP) may reflect neurological injury in pre-eclampsia. We assessed if there was a correlation between cognitive function assessment scores and plasma concentrations of these biomarkers in pre-eclampsia. STUDY DESIGN Women with eclampsia, pre-eclampsia and normotensive pregnancies from the South African PROVE biobank were included. Blood samples were taken at inclusion. The Montreal Cognitive Assessment was performed after delivery at the time of discharge. The correlation between cognitive assessment scores and plasma concentrations of cerebral biomarkers was analysed using Spearman correlation adjusted for time from eclamptic seizure. MAIN OUTCOME MEASURES We included 49 women with eclampsia, 16 women with pre-eclampsia complicated by pulmonary oedema, 22 women with pre-eclampsia without pulmonary oedema, HELLP or neurological complications and 18 women with normotensive pregnancies. RESULTS There was a correlation between impaired cognitive function and increased plasma concentrations of NfL in women with eclampsia and women with pre-eclampsia and pulmonary oedema (r = -0.37, p = 0.009 and r = -0.56, p = 0.025 respectively). No correlation between impaired cognitive function and NfL in pre-eclampsia cases without pulmonary oedema, HELLP or neurological complications or normotensive pregnancies was found. No correlation with cognitive impairment was found in any groups for tau or GFAP. CONCLUSIONS We found a correlation between impaired cognitive function assessment and plasma NfL concentrations in women with eclampsia and pre-eclampsia complicated by pulmonary oedema. These findings suggest that acute neuroaxonal injury may cause or contribute to cognitive impairment in these women.
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Affiliation(s)
- Emma Bokström-Rees
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; UCL Institute of Neurology, Department of Neurodegenerative Disease, Queen Square, London, UK; UK Dementia Research Institute, London, UK; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roxanne Hastie
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sonja Schell
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Catherine Cluver
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia; Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Lina Bergman
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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11
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Kovacheva VP, Eberhard BW, Cohen RY, Maher M, Saxena R, Gray KJ. Prediction of Preeclampsia from Clinical and Genetic Risk Factors in Early and Late Pregnancy Using Machine Learning and Polygenic Risk Scores. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.03.23285385. [PMID: 36798188 PMCID: PMC9934723 DOI: 10.1101/2023.02.03.23285385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Background Preeclampsia, a pregnancy-specific condition associated with new-onset hypertension after 20 weeks gestation, is a leading cause of maternal and neonatal morbidity and mortality. Predictive tools to understand which individuals are most at risk are needed. Methods We identified a cohort of N=1,125 pregnant individuals who delivered between 05/2015-05/2022 at Mass General Brigham hospitals with available electronic health record (EHR) data and linked genetic data. Using clinical EHR data and systolic blood pressure polygenic risk scores (SBP PRS) derived from a large genome-wide association study, we developed machine learning (xgboost) and linear regression models to predict preeclampsia risk. Results Pregnant individuals with an SBP PRS in the top quartile had higher blood pressures throughout pregnancy compared to patients within the lowest quartile SBP PRS. In the first trimester, the most predictive model was xgboost, with an area under the curve (AUC) of 0.73. Adding the SBP PRS to the models improved the performance only of the linear regression model from AUC 0.70 to 0.71; the predictive power of other models remained unchanged. In late pregnancy, with data obtained up to the delivery admission, the best performing model was xgboost using clinical variables, which achieved an AUC of 0.91. Conclusions Integrating clinical and genetic factors into predictive models can inform personalized preeclampsia risk and achieve higher predictive power than the current practice. In the future, personalized tools can be implemented in clinical practice to identify high-risk patients for preventative therapies and timely intervention to improve adverse maternal and neonatal outcomes.
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12
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Wei X, Zhou S, Liao L, Liu M, Gao Y, Yin Y, Xu Q, Zhou R. Comprehensive analysis of transcriptomic profiling of 5-methylcytosin modification in placentas from preeclampsia and normotensive pregnancies. FASEB J 2023; 37:e22751. [PMID: 36692426 DOI: 10.1096/fj.202201248r] [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: 08/03/2022] [Revised: 11/09/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
Increasing evidence suggests that RNA m5C modification and its regulators have been confirmed to be associated with the pathogenesis of many diseases. However, the distribution and biological functions of m5C in mRNAs of placental tissues remain unknown. we collected placentae from normotensive pregnancies (CTR) and preeclampsia patients (PE) to analyze the transcriptomic profiling of m5C RNA methylation through m5C RNA immunoprecipitation (UMI-MeRIP-Seq). we discovered that overall m5C methylation peaks were decreased in placental tissues from PE patients. And, 2844 aberrant m5C peaks were identified, of which respectively 1304 m5C peaks were upregulated and 1540 peaks were downregulated. The distribution of m5C peaks were mainly located in CDS (coding sequences) regions in placental tissues of both groups, but compared with the CTR group, the m5C peak in PE group before the stop code of CDS was significantly increased and even higher than the peak value after start code in CDS. Differentially methylated genes were mainly enriched in MAPK/cAMP signaling pathway. Moreover, the up-regulated genes with hypermethylated modification were enriched in the processes of hypoxia, inflammation/immune response. Finally, through analyzing the mRNA expression levels of m5C RNA methylation regulators, we found only DNMT3B and TET3 were significantly upregulated in PE samples than in control group. And they are not only negatively correlated with each other, but also closely related to those differentially expressed genes modified by differential methylation.Our findings provide new insights regarding alterations of m5C RNA modification into the pathogenic mechanisms of PE.
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Affiliation(s)
- Xiaohong Wei
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, NHC Key Laboratory of Chronobiology, Sichuan University, Ministry of Education, Chengdu, China
| | - Shengping Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, NHC Key Laboratory of Chronobiology, Sichuan University, Ministry of Education, Chengdu, China
| | - Lingyun Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, NHC Key Laboratory of Chronobiology, Sichuan University, Ministry of Education, Chengdu, China
| | - Min Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, NHC Key Laboratory of Chronobiology, Sichuan University, Ministry of Education, Chengdu, China
| | - Yijie Gao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, NHC Key Laboratory of Chronobiology, Sichuan University, Ministry of Education, Chengdu, China
| | - Yangxue Yin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, NHC Key Laboratory of Chronobiology, Sichuan University, Ministry of Education, Chengdu, China
| | - Qin Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, NHC Key Laboratory of Chronobiology, Sichuan University, Ministry of Education, Chengdu, China
| | - Rong Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, NHC Key Laboratory of Chronobiology, Sichuan University, Ministry of Education, Chengdu, China
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13
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van Boekholt TA, Moturi E, Hölscher H, Schulte-Hillen C, Tappis H, Burton A. Review of maternal death audits in refugee camps in UNHCR East and Horn of Africa and Great Lakes Region, 2017-2019. Int J Gynaecol Obstet 2023; 160:483-491. [PMID: 36217727 PMCID: PMC10092615 DOI: 10.1002/ijgo.14504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/25/2022] [Accepted: 10/02/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To review the quality of maternal death audits and identify factors contributing to refugee maternal deaths in the East and Horn of Africa. METHODS Maternal death audits submitted to The UN Refugee Agency (UNHCR) from 2017 to 2019 in 43 refugee camps in eight countries were analyzed for completeness, obstetric history, cause of death, and contributing factors. RESULTS A total of 191 refugee maternal death audits were retrieved. The mean age of the deceased was 28 years (range, 15-45 years), and 13% were adolescents and 17% were of advanced maternal age. Most patients (55%) were grand multigravida (≥5 pregnancies). The majority (86%) attended antenatal care visits, with 51% attending four or more visits. Among women who delivered (n = 140), 91% were facility-based deliveries. Most (68%) deaths occurred postpartum. Obstetric hemorrhage (49%) was the leading direct cause of death (with 77 cases of postpartum hemorrhage), followed by hypertensive disorder (19%) and infection (15%). Delays in care were identified in 185 (97%) cases. Delays in receiving care were more prevalent (81%) than in seeking (61%) and reaching (26%) care. CONCLUSION Factors contributing to delays in receiving care highlight the capacity gaps in provision of emergency obstetric care, including management of postpartum hemorrhage, requiring urgent additional investments. Audit findings also show the need for attention and action towards family planning, contraception, and adolescent sexual and reproductive health services.
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Affiliation(s)
- Tessa A van Boekholt
- UNHCR Regional Bureau of East and Horn of Africa and Great Lakes, Nairobi, Kenya
| | - Edna Moturi
- UNHCR Regional Bureau of East and Horn of Africa and Great Lakes, Nairobi, Kenya
| | | | | | - Hannah Tappis
- John Hopkins Center for Humanitarian Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ann Burton
- UNHCR Public Health Section, Geneva, Switzerland
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14
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Dol J, Hughes B, Bonet M, Dorey R, Dorling J, Grant A, Langlois EV, Monaghan J, Ollivier R, Parker R, Roos N, Scott H, Shin HD, Curran J. Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review. JBI Evid Synth 2022; 21:98-199. [PMID: 36300916 PMCID: PMC9794155 DOI: 10.11124/jbies-21-00479] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this review was to determine the timing of overall and cause-specific neonatal mortality and severe morbidity during the postnatal period (1-28 days). INTRODUCTION Despite significant focus on improving neonatal outcomes, many newborns continue to die or experience adverse health outcomes. While evidence on neonatal mortality and severe morbidity rates and causes are regularly updated, less is known on the specific timing of when they occur in the neonatal period. INCLUSION CRITERIA This review considered studies that reported on neonatal mortality daily in the first week; weekly in the first month; or day 1, days 2-7, and days 8-28. It also considered studies that reported on timing of severe neonatal morbidity. Studies that reported solely on preterm or high-risk infants were excluded, as these infants require specialized care. Due to the available evidence, mixed samples were included (eg, both preterm and full-term infants), reflecting a neonatal population that may include both low-risk and high-risk infants. METHODS MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and updated on May 10, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by 2 reviewers using a study-specific data extraction form. All conflicts were resolved through consensus or discussion with a third reviewer. Where possible, quantitative data were pooled in statistical meta-analysis. Where statistical pooling was not possible, findings were reported narratively. RESULTS A total of 51 studies from 36 articles reported on relevant outcomes. Of the 48 studies that reported on timing of mortality, there were 6,760,731 live births and 47,551 neonatal deaths with timing known. Of the 34 studies that reported daily deaths in the first week, the highest proportion of deaths occurred on the first day (first 24 hours, 38.8%), followed by day 2 (24-48 hours, 12.3%). Considering weekly mortality within the first month (n = 16 studies), the first week had the highest mortality (71.7%). Based on data from 46 studies, the highest proportion of deaths occurred on day 1 (39.5%), followed closely by days 2-7 (36.8%), with the remainder occurring between days 8 and 28 (23.0%). In terms of causes, birth asphyxia accounted for the highest proportion of deaths on day 1 (68.1%), severe infection between days 2 and 7 (48.1%), and diarrhea between days 8 and 28 (62.7%). Due to heterogeneity, neonatal morbidity data were described narratively. The mean critical appraisal score of all studies was 84% (SD = 16%). CONCLUSION Newborns experience high mortality throughout the entire postnatal period, with the highest mortality rate in the first week, particularly on the first day. Ensuring regular high-quality postnatal visits, particularly within the first week after birth, is paramount to reduce neonatal mortality and severe morbidity.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Brianna Hughes
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada,School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachel Dorey
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Jon Dorling
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Amy Grant
- Maritime SPOR Support Unit, Halifax, NS, Canada
| | - Etienne V. Langlois
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Geneva, Switzerland
| | - Joelle Monaghan
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Robin Parker
- W.K. Kellogg Health Sciences Library, Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Nathalie Roos
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Heather Scott
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Hwayeon Danielle Shin
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada,School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Janet Curran
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada,School of Nursing, Dalhousie University, Halifax, NS, Canada
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15
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Kitt E, Hayes M, Congdon M, Ballester L, Sewawa KB, Mulale U, Mazhani L, Arscott-Mills T, Steenhoff A, Coffin S. Risk factors for mortality in a hospitalised neonatal cohort in Botswana. BMJ Open 2022; 12:e062776. [PMID: 36691117 PMCID: PMC9454043 DOI: 10.1136/bmjopen-2022-062776] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/24/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES A disproportionate number of neonatal deaths occur in low/middle-income countries, with sepsis a leading contributor of mortality. In this study, we investigate risk factors for mortality in a cohort of high-risk hospitalised neonates in Botswana. Independent predictors for mortality for infants experiencing either a sepsis or a non-sepsis-related death are described. METHODS This is a prospective observational cohort study with infants enrolled from July to October 2018 at the neonatal unit (NNU) of Princess Marina Hospital (PMH) in Gaborone, Botswana. Data on demographic, clinical and unit-specific variables were obtained. Neonates were followed to death or discharge, including transfer to another hospital. Death was determined to be infectious versus non-infectious based on primary diagnosis listed on day of death by lead clinician on duty. RESULTS Our full cohort consisted of 229 patients. The overall death rate was 227 per 1000 live births, with cumulative proportion of deaths of 22.7% (n=47). Univariate analysis revealed that sepsis, extremely low birth weight (ELBW) status, hypoxic ischaemic encephalopathy, critical illness and infants born at home were associated with an increased risk of all-cause mortality. Our multivariate model revealed that critical illness (HR 3.07, 95% CI 1.56 to 6.03) and being born at home (HR 4.82, 95% CI 1.76 to 13.19) were independently associated with all-cause mortality. Low birth weight status was independently associated with a decreased risk of mortality (HR 0.24, 95% CI 0.11 to 0.53). There was a high burden of infection in the cohort with more than half of infants (140, 61.14%) diagnosed with sepsis at least once during their NNU admission. Approximately 20% (n=25) of infants with sepsis died before discharge. Our univariate subanalysis of the sepsis cohort revealed that ELBW and critical illness were associated with an increased risk of death. These findings persisted in the multivariate model with HR 3.60 (95% CI 1.11 to 11.71) and HR 2.39 (95% CI 1 to 5.77), respectively. CONCLUSIONS High rates of neonatal mortality were noted. Urgent interventions are needed to improve survival rates at PMH NNU and to prioritise care for critically ill infants at time of NNU admission, particularly those born at home and/or of ELBW.
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Affiliation(s)
- Eimear Kitt
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly Hayes
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Morgan Congdon
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Section of Hospital Medicine, CHOP, Philadelphia, Pennsylvania, USA
| | - Lance Ballester
- Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kgotlaetsile B Sewawa
- Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, South-East District, Botswana
| | - Unami Mulale
- Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, South-East District, Botswana
| | - Loeto Mazhani
- Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, South-East District, Botswana
| | - Tonya Arscott-Mills
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew Steenhoff
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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16
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August F, Nyamhanga T, Kakoko D, Nathanaeli S, Frumence G. Perceptions and Experiences of Health Care Workers on Accountability Mechanisms for Enhancing Quality Improvement in the Delivery of Maternal Newborns and Child Health Services in Mkuranga, Tanzania. Front Glob Womens Health 2022; 3:868502. [PMID: 35846559 PMCID: PMC9279912 DOI: 10.3389/fgwh.2022.868502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMaternal mortality estimates globally show that by 2017 there were still 211 deaths per 100,000 live births; more strikingly, 99% of them happen in low and middle-income countries, including Tanzania. There has been insufficient progress in improving maternal and newborn health despite the efforts to strengthen the health systems, to improve the quality of maternal health in terms of training and deploying human resources for health, constructing health facilities, and supplying medical products. However, fewer efforts are invested in enhancing accountability toward the improvement of the quality of maternal health care. This the study was conducted to explore the perceptions of healthcare workers regarding accountability mechanisms for enhancing quality improvement in the delivery of maternal newborn and child health services in Tanzania.MethodsWe adopted phenomenology as a study design to understand how health workers perceive accountability and data were collected using semi-structured interviews. We then used thematic analysis to analyze themes and sub- themes.ResultsThe study revealed four categories of perceptions namely, differences in the conceptualization of accountability and accountability mechanisms, varied opinions about the existing accountability mechanisms, perceived the usefulness of accountability mechanisms, together with perceived challenges in the enforcement of accountability mechanisms.ConclusionPerceived variations in the understanding of accountability among healthcare workers signaled a proper but fragmented understanding of accountability in maternal care. Accountability mechanisms are perceived to be useful for enhancing hard work in the provision of maternal health services. Moreover, inadequate motivation resulting from health system bottlenecks tend to constrain enforcement of accountability in the provision of maternal care services. Thus, we recommend that the government should deal with health system constraints and enforce regular monitoring and supervision.
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Affiliation(s)
- Francis August
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- *Correspondence: Francis August
| | - Tumaini Nyamhanga
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deodatus Kakoko
- Department of Behavioral Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sirili Nathanaeli
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Ilyes SG, Chiriac VD, Gluhovschi A, Mihaela V, Dahma G, Mocanu AG, Neamtu R, Silaghi C, Radu D, Bernad E, Craina M. The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060709. [PMID: 35743972 PMCID: PMC9229487 DOI: 10.3390/medicina58060709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union’s most recent demographic data, it had the second-highest infant death rate in 2019. Although significant progress has been made in the last three decades in lowering newborn mortality, more initiatives to accelerate progress are required to meet the 2030 Sustainable Development Goals (SDG) objective. Therefore, we aimed to develop an observational study to determine the influence of maternal factors on in-hospital neonatal intensive care unit admission and mortality in premature infants born in western Romania. While newborn mortality has decreased globally, the pace of decline is far less than what is desired. Materials and Methods: A retrospective study comprising 328 premature patients and 422 full-term newborns, was developed at a tertiary obstetrics and gynecology clinic in western Romania, comprising the period of the last 24 months before the COVID-19 pandemic and the first 24 months of the pandemic. Results: The following variables were identified as statistically significant risk factors for neonatal intensive care unit admission: age > 35 years, OR = 1.59; twin births, OR = 1.14; low gestational age, OR = 1.66; preeclampsia, OR = 2.33; and peripartum infection, OR = 2.25. The same risk factors, with the exception of twin births, were significantly associated with in-hospital neonatal mortality. Except for a longer duration of maternal hospitalization and neonatal therapy with surfactant, steroids, and antibiotics, the COVID-19 pandemic did not cause significant differences in the evolution and outcomes of preterm newborns. Conclusions: The major maternal risk factors for NICU admission were advanced age, twin pregnancy, low gestational age, preeclampsia, and peripartum infection. Additionally, these characteristics contributed to a high likelihood of death, despite adequate access to medical care and advanced life support for the neonates. Understanding the causes of morbidity and death in neonates admitted to the neonatal intensive care unit enables better prioritization and planning of health services, resource reallocation, and care quality improvement.
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Affiliation(s)
- Stelian-Gabriel Ilyes
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Veronica Daniela Chiriac
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
- Correspondence: ; Tel.: +40-729-098-886
| | - Adrian Gluhovschi
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Valcovici Mihaela
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - George Dahma
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Adelina Geanina Mocanu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Radu Neamtu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Carmen Silaghi
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Daniela Radu
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Elena Bernad
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Marius Craina
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
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Kang T, Liu Y, Chen X, Huang X, Cao Y, Dou W, Duan D, Bo Y, Traore SS, Zhao X, Fu W, Zeng F, Liu J, Lyu Q. Dietary carotenoid intake and risk of developing preeclampsia: a hospital-based case-control study. BMC Pregnancy Childbirth 2022; 22:427. [PMID: 35597902 PMCID: PMC9123797 DOI: 10.1186/s12884-022-04737-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background The effect of carotenoids on the risk of preeclampsia (PE) is uncertain. We aimed to examine the associations between the intake of dietary carotenoids and related compounds by pregnant women in China, and the risk of their developing PE. Methods Four hundred and forty PE cases and 440 age- (± 3 years), gestational age- (± 1 weeks) and gestational diabetes mellitus status- (yes/no) matched healthy controls were recruited from March 2016 to June 2019. Dietary intake of carotenoids was assessed using a 79-item validated food-frequency questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. Results After adjusting for potential confounders, we found that the intake of total carotenoids, β-carotene, β-cryptoxanthin, lycopene, and lutein and zeaxanthin (lut-zea) were negatively associated with the odds of developing PE. Compared with the lowest quartile intake, the multivariate-adjusted OR (95% CI) of the highest quartile intake was 0.29 (0.16–0.54, Ptrend < 0.001) for total carotenoids, 0.31 (0.16–0.58, Ptrend < 0.001) for β-carotene, 0.50 (0.27–0.90, Ptrend = 0.007) for β-cryptoxanthin, 0.55 (0.30–0.99, Ptrend = 0.04) for lycopene and 0.32 (0.17–0.61, Ptrend = 0.001) for lut-zea. However, no significant associations were observed between the risk of developing PE and α-carotene intake (OR = 0.75, 95% CI: 0.41–1.36, Ptrend = 0.28). Moreover, similar negative associations were found for every one-standard-deviation increase in the intake of total carotenoids, β-carotene, β-cryptoxanthin, lycopene and lut-zea. Conclusion These results indicate that a high intake of total carotenoids, β-carotene, β-cryptoxanthin, lycopene and lut-zea may be associated with a low risk of developing PE. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04737-5.
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Affiliation(s)
- Ting Kang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yanhua Liu
- Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| | - Xi Chen
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Xuemin Huang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yuan Cao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Weifeng Dou
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Dandan Duan
- Department of Clinical Nutrition, Luoyang New Area Peoples Hospital, Luoyang, 471023, Henan, China
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Stanislav Seydou Traore
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Xianlan Zhao
- Department of Obstetrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Wenjun Fu
- Department of Obstetrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Fangfang Zeng
- Department of Epidemiology, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Jun Liu
- Department of Preventive Medicine, School of Public Health, Zunyi Medical University, Zunyi, 563006, Guizhou, China
| | - Quanjun Lyu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China. .,Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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19
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Bester M, Joshi R, Mischi M, van Laar JOEH, Vullings R. Longitudinally Tracking Maternal Autonomic Modulation During Normal Pregnancy With Comprehensive Heart Rate Variability Analyses. Front Physiol 2022; 13:874684. [PMID: 35615673 PMCID: PMC9125027 DOI: 10.3389/fphys.2022.874684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/31/2022] [Indexed: 12/28/2022] Open
Abstract
Changes in the maternal autonomic nervous system are essential in facilitating the physiological changes that pregnancy necessitates. Insufficient autonomic adaptation is linked to complications such as hypertensive diseases of pregnancy. Consequently, tracking autonomic modulation during progressing pregnancy could allow for the early detection of emerging deteriorations in maternal health. Autonomic modulation can be longitudinally and unobtrusively monitored by assessing heart rate variability (HRV). Yet, changes in maternal HRV (mHRV) throughout pregnancy remain poorly understood. In previous studies, mHRV is typically assessed only once per trimester with standard HRV features. However, since gestational changes are complex and dynamic, assessing mHRV comprehensively and more frequently may better showcase the changing autonomic modulation over pregnancy. Subsequently, we longitudinally (median sessions = 8) assess mHRV in 29 healthy pregnancies with features that assess sympathetic and parasympathetic activity, as well as heart rate (HR) complexity, HR responsiveness and HR fragmentation. We find that vagal activity, HR complexity, HR responsiveness, and HR fragmentation significantly decrease. Their associated effect sizes are small, suggesting that the increasing demands of advancing gestation are well tolerated. Furthermore, we find a notable change in autonomic activity during the transition from the second to third trimester, highlighting the dynamic nature of changes in pregnancy. Lastly, while we saw the expected rise in mean HR with gestational age, we also observed increased autonomic deceleration activity, seemingly to counter this rising mean HR. These results are an important step towards gaining insights into gestational physiology as well as tracking maternal health via mHRV.
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Affiliation(s)
- Maretha Bester
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Patient Care and Monitoring, Philips Research, Eindhoven, Netherlands
- *Correspondence: Maretha Bester,
| | - Rohan Joshi
- Patient Care and Monitoring, Philips Research, Eindhoven, Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Judith O. E. H. van Laar
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Obstetrics and Gynecology, Máxima Medical Centrum, Veldhoven, Netherlands
| | - Rik Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Willy D, Willy K, Köster HA, Braun J, Möllers M, Sourouni M, Klockenbusch W, Schmitz R, Oelmeier K. Blood Pressure Levels and Maternal Outcome in Women with Preeclampsia – a Retrospective Study from a Large Tertiary Obstetric Centre. Geburtshilfe Frauenheilkd 2022; 82:528-534. [PMID: 35528191 PMCID: PMC9076217 DOI: 10.1055/a-1783-7718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/26/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction
Patients with high blood pressure levels are at high risk for acute complications as well as serious long-term consequences. Women with preeclampsia often experience
very high blood pressure levels during pregnancy and postpartum and are also known to have a higher cardiovascular risk in later life.
Material and Methods
In our single-centre retrospective cohort study, we analysed 158 pregnancies complicated by preeclampsia in regard to maternal outcome. We divided the patient
cohort into three subgroups according to the blood pressure levels during hospital stay.
Results
Pre-existing arterial hypertension was significantly more common in patients with a hypertensive crisis (systolic blood pressure ≥ 180 mmHg and/or diastolic blood pressure
≥ 120 mmHg) during pregnancy than in patients with moderate or severe hypertension (p = 0.001). Women with a hypertensive crisis had an unfavourable outcome compared to women with lower
blood pressure levels. These women developed a HELLP-syndrome significantly more often (p = 0.013). Moreover, most of the women with a hypertensive crisis during pregnancy were still
hypertensive at hospital discharge (p = 0.004), even though they were administrated antihypertensive agents more often (p < 0.001) compared to women with lower blood pressure values.
Conclusion
Preeclamptic women with hypertensive crises should be identified quickly and monitored closely to avoid further complications. Standardized follow-up programs are lacking,
but especially these patients seem to be at high risk for persistent hypertension and increased cardiovascular morbidity and therefore should receive specialist follow-up, including
hypertensiologists, cardiologists and gynaecologists. Large prospective trials are required for a better understanding of these interrelations and to develop a specific follow-up
program.
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Affiliation(s)
- Daniela Willy
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Kevin Willy
- Department of Cardiology, University Hospital Münster, Münster, Germany
| | - Helen-Ann Köster
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Janina Braun
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Marina Sourouni
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Walter Klockenbusch
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
| | - Kathrin Oelmeier
- Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany
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21
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Cheung KW, Tan LN, Meher S. Clinical algorithms for the management of intrapartum maternal urine abnormalities. BJOG 2022. [PMID: 35415941 DOI: 10.1111/1471-0528.16726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022]
Abstract
AIM To develop evidence-based clinical algorithms for management of common intrapartum urinary abnormalities. POPULATION Women with singleton, term pregnancies in active labour and immediate postnatal period, at low risk of complications. SETTING Healthcare facilities in low- and middle-income countries. SEARCH STRATEGY A systematic search and review were conducted on the current guidelines from WHO, NICE, ACOG and RCOG. Additional search was done on PubMed and The Cochrane Database of Systematic Reviews up to May 2020. CASE SCENARIOS Four common intrapartum urinary abnormalities were selected: proteinuria, ketonuria, glycosuria and oliguria. Using reagent strip testing, glycosuria was defined as ≥2+ on one occasion or of ≥1+ on two or more occasions. Proteinuria was defined as ≥2+ and presence of ketone indicated ketonuria. Oliguria was defined as hourly urine output ≤30 ml. Thorough initial assessment using history, physical examination and basic investigations helped differentiate most of the underlying causes, which include diabetes mellitus, dehydration, sepsis, pre-eclampsia, shock, anaemia, obstructed labour, underlying cardiac or renal problems. A clinical algorithm was developed for each urinary abnormality to facilitate intrapartum management and referral of complicated cases for specialised care. CONCLUSIONS Four simple, user-friendly and evidence-based clinical algorithms were developed to enhance intrapartum care of commonly encountered maternal urine abnormalities. These algorithms may be used to support healthcare professionals in clinical decision-making when handling normal and potentially complicated labour, especially in low resource countries. TWEETABLE ABSTRACT Evidence-based clinical algorithms developed to guide intrapartum management of commonly encountered urinary abnormalities.
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Affiliation(s)
- K W Cheung
- The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong City, Hong Kong SAR, China
| | - L N Tan
- The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
- Department of Obstetrics and Gynaecology, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - S Meher
- The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
- Institute of Metabolism and Systems Research, University of Birmingam, Birmingham, UK
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22
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Dol J, Hughes B, Bonet M, Dorey R, Dorling J, Grant A, Langlois EV, Monaghan J, Ollivier R, Parker R, Roos N, Scott H, Shin HD, Curran J. Timing of maternal mortality and severe morbidity during the postpartum period. JBI Evid Synth 2022; 20:2119-2194. [PMID: 35916004 PMCID: PMC9594153 DOI: 10.11124/jbies-20-00578] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: The objective of this review was to determine the timing of overall and cause-specific maternal mortality and severe morbidity during the postpartum period. Introduction: Many women continue to die or experience adverse health outcomes in the postpartum period; however, limited work has explored the timing of when women die or present complications during this period globally. Inclusion criteria: This review considered studies that reported on women after birth up to 6 weeks postpartum and included data on mortality and/or morbidity on the first day, days 2–7, and days 8–42. Studies that reported solely on high-risk women (eg, those with antenatal or intrapartum complications) were excluded, but mixed population samples were included (eg, low-risk and high-risk women). Methods: MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and searches were updated on May 11, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by at least 2 reviewers using a study-specific data extraction form. Quantitative data were pooled, where possible. Identified studies were used to obtain the summary estimate (proportion) for each time point. Maternal mortality was calculated as the maternal deaths during a given period over the total number of maternal deaths known during the postpartum period. For cause-specific analysis, number of deaths due to a specific cause was the numerator, while the total number of women who died due to the same cause in that period was the denominator. Random effects models were run to pool incidence proportion for relative risk of overall maternal deaths. Subgroup analysis was conducted according to country income classification and by date (ie, data collection before or after 2010). Where statistical pooling was not possible, the findings were reported narratively. Results: A total of 32 studies reported on maternal outcomes from 17 reports, all reporting on mixed populations. Most maternal deaths occurred on the first day (48.9%), with 24.5% of deaths occurring between days 2 and 7, and 24.9% occurring between days 8 and 42. Maternal mortality due to postpartum hemorrhage and embolism occurred predominantly on the first day (79.1% and 58.2%, respectively). Most deaths due to postpartum eclampsia and hypertensive disorders occurred within the first week (44.3% on day 1 and 37.1% on days 2–7). Most deaths due to infection occurred between days 8 and 42 (61.3%). Due to heterogeneity, maternal morbidity data are described narratively, with morbidity predominantly occurring within the first 2 weeks. The mean critical appraisal score across all included studies was 85.9% (standard deviation = 13.6%). Conclusion: Women experience mortality throughout the entire postpartum period, with the highest mortality rate on the first day. Access to high-quality care during the postpartum period, including enhanced frequency and quality of postpartum assessments during the first 42 days after birth, is essential to improving maternal outcomes and to continue reducing maternal mortality and morbidity worldwide. Systematic review registration number: PROSPERO CRD42020187341
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Brianna Hughes
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Mercedes Bonet
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachel Dorey
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Jon Dorling
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Amy Grant
- Maritime SPOR Support Unit, Halifax, NS, Canada
| | - Etienne V. Langlois
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Geneva, Switzerland
| | - Joelle Monaghan
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Robin Parker
- W.K. Kellogg Health Sciences Library, Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Nathalie Roos
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Heather Scott
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Hwayeon Danielle Shin
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Janet Curran
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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Li B, Yang H. Comparison of clinical features and pregnancy outcomes in early- and late-onset preeclampsia with HELLP syndrome: a 10-year retrospective study from a tertiary hospital and referral center in China. BMC Pregnancy Childbirth 2022; 22:186. [PMID: 35260082 PMCID: PMC8903662 DOI: 10.1186/s12884-022-04466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE) are different subtypes of preeclampsia. We conducted this study to analyze the similarities and differences in the clinical features and pregnancy outcomes in EO- and LO-PE with HELLP syndrome. Methods This was a retrospective study in a tertiary hospital. Eighty-three parturients with HELLP syndrome were allocated into two groups based on the timing of preeclampsia onset: EO-PE with HELLP (n = 47) and LO-PE with HELLP (n = 36). Results In total, 31.9% and 63.9% of women in the EO-PE with HELLP and LO-PE with HELLP groups, respectively, were asymptomatic at diagnosis (P = 0.004, OR = 0.265 (0.106–0.662)). Headache or visual symptoms were more frequent in the EO-PE group than in the LO-PE group (48.9% vs. 25%, P = 0.026, OR = 0.348 (0.135–0.896)). Women in the EO-PE with HELLP group had higher SBP and DBP than those in the LO-PE with HELLP group. Laboratory tests, including platelets, liver function, and hemolysis, which are the main indicators for the diagnosis of HELLP syndrome, showed almost no significant differences between the two groups, with kidney function being the only difference observed. Women in the EO-PE with HELLP group had higher Scr than those in the LO-PE with HELLP group. The degree of proteinuria was higher in the EO-PE group than in the LO-PE with HELLP group. The incidence of severe maternal complications was significantly higher in the EO-PE group than in the LO-PE with HELLP group (25.5% vs. 5.6%, P = 0.016, OR = 0.172 (0.036–0.824)). In total, 57.4% and 8.3% of neonates in the EO-PE and LO-PE with HELLP groups were admitted to the NICU, and the difference was statistically significant, even after adjustment for the delivery week (P = 0.009, OR = 0.830 (0.729–0.944)). Postpartum HELLP syndrome was more common in the LO-PE group than in the EO-PE group (30.6% vs. 4.3%, P = 0.001, OR = 9.9 (2.031–48.256)). Conclusions Compared with LO-PE with HELLP patients, EO-PE with HELLP patients have more obvious kidney damage, higher blood pressure and a higher risk of adverse maternal and neonatal outcomes. Patients with LO-PE need to be alerted to the occurrence of HELLP syndrome after delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04466-9.
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Affiliation(s)
- Boya Li
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
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24
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Manoochehri Z, Manoochehri S, Soltani F, Tapak L, Sadeghifar M. Predicting preeclampsia and related risk factors using data mining approaches: A cross-sectional study. Int J Reprod Biomed 2022; 19:959-968. [PMID: 34977453 PMCID: PMC8717074 DOI: 10.18502/ijrm.v19i11.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/23/2020] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Preeclampsia is a type of pregnancy hypertension disorder that has adverse effects on both the mother and the fetus. Despite recent advances in the etiology of preeclampsia, no adequate clinical screening tests have been identified to diagnose the disorder. Objective We aimed to provide a model based on data mining approaches that can be used as a screening tool to identify patients with this syndrome and also to identify the risk factors associated with it. Materials and Methods The data used to perform this cross-sectional study were extracted from the clinical records of 726 mothers with preeclampsia and 726 mothers without preeclampsia who were referred to Fatemieh Hospital in Hamadan City during April 2005–March 2015. In this study, six data mining methods were adopted, including logistic regression, k-nearest neighborhood, C5.0 decision tree, discriminant analysis, random forest, and support vector machine, and their performance was compared using the criteria of accuracy, sensitivity, and specificity. Results Underlying condition, age, pregnancy season and the number of pregnancies were the most important risk factors for diagnosing preeclampsia. The accuracy of the models were as follows: logistic regression (0.713), k-nearest neighborhood (0.742), C5.0 decision tree (0.788), discriminant analysis (0.687), random forest (0.758) and support vector machine (0.791). Conclusion Among the data mining methods employed in this study, support vector machine was the most accurate in predicting preeclampsia. Therefore, this model can be considered as a screening tool to diagnose this disorder.
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Affiliation(s)
- Zohreh Manoochehri
- Department of Biostatistics, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sara Manoochehri
- Department of Biostatistics, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farzaneh Soltani
- Department of Midwifery, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leili Tapak
- Modeling of Noncommunicable Disease Research Center, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Sadeghifar
- Department of Statistics, Faculty of Basic Sciences, Bu-Ali Sina University, Hamadan, Iran
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25
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Nobrega AAD, Mendes YMMBE, Miranda MJD, Santos ACCD, Lobo ADP, Porto DL, França GVAD. Mortalidade perinatal no Brasil em 2018: análise epidemiológica segundo a classificação de Wiggleworth modificada. CAD SAUDE PUBLICA 2022; 38:e00003121. [DOI: 10.1590/0102-311x00003121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/15/2021] [Indexed: 11/21/2022] Open
Abstract
Resumo: A mortalidade perinatal engloba a mortalidade fetal e a neonatal precoce (0 a 6 dias). Este estudo descreveu os óbitos perinatais ocorridos no Brasil em 2018, segundo a classificação de Wigglesworth modificada. As fontes de dados foram os Sistemas de Informações sobre Mortalidade e sobre Nascidos Vivos. Foram calculadas as taxas de mortalidade fetal e perinatal por mil nascimentos totais (nascidos vivos mais natimortos) e a taxa de mortalidade neonatal precoce por mil nascidos vivos, e comparadas usando seus respectivos intervalos de 95% de confiança (IC95%). Os óbitos perinatais foram classificados nos grupos de causas anteparto, anomalias congênitas, prematuridade, asfixia e causas específicas. Foi calculado, para cada grupo de causas, o número de óbitos por faixa de peso, além das taxas de mortalidade e os respectivos IC95%, e feita a distribuição espacial das taxas de mortalidade por Unidade da Federação (UF). Foram registrados 35.857 óbitos infantis, sendo 18.866 (52,6%) neonatais precoces; os natimortos somaram 27.009. Os óbitos perinatais totalizaram 45.875, perfazendo uma taxa de mortalidade de 15,5‰ nascimentos. A maior taxa de mortalidade (7,6‰; 7,5‰-7,7‰) foi observada no grupo anteparto, seguido da prematuridade (3,6‰; 3,6‰-3,7‰). No grupo anteparto, 14 das 27 UFs (sendo oito na Região Nordeste e quatro na Região Norte) apresentaram as taxas de mortalidade perinatal acima da nacional. A taxa de mortalidade perinatal no Brasil mostrou-se elevada, e a maioria dos óbitos poderia ser prevenida com investimento em cuidados pré-natais e ao nascimento.
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Liu Y, Li Q, Wang T, Zhang S, Chen L, Li Y, Diao J, Li J, Song X, Sun M, Wei J, Shu J, Yang T, Qin J. Determinants for Perinatal Mortality in South China: A Prospective Cohort Study. Front Pediatr 2022; 10:756444. [PMID: 35372159 PMCID: PMC8975146 DOI: 10.3389/fped.2022.756444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the association of selected maternal and fetal characteristics with the risk of perinatal mortality in South China. METHODS A prospective cohort study was conducted from March 2013 to December 2019. The exposures of interest were maternal sociodemographic characteristics, lifestyle and habits during early pregnancy, and complications of pregnancy. Their effects on the development of perinatal death were analyzed in our study. RESULTS A total of 44,048 eligible pregnant women were included in the analysis. Of these, 596 fetuses were perinatal deaths (perinatal mortality was 13.5 per 1,000 births). After adjustment, maternal obesity, being employed, history of gestational hypertension, taking antidepressants during early pregnancy, history of gestational diabetes mellitus, gestational diabetes mellitus, infertility drug treatment and assisted reproductive techniques, history of neonatal death, preterm birth, and congenital malformations all significantly increased the risk of perinatal death. Ethnic minority, income > 5,000, multiparous women, and cesarean section associated with reduced risk of perinatal death. CONCLUSION Some factors of maternal sociodemographic characteristics, abnormal pregnancy history, lifestyle and habits during early pregnancy, and complications of pregnancy were associated with the risk of perinatal death.
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Affiliation(s)
- Yiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Qiongxuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,National Health Committee (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Letao Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yihuan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jingyi Diao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jinqi Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xinli Song
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Mengting Sun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jianhui Wei
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jing Shu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,National Health Committee (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Wu JN, Li MQ, Xie F, Zhang B. Gestational week-specific of uterine artery Doppler indices in predicting preeclampsia: a hospital-based retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:843. [PMID: 34952577 PMCID: PMC8705461 DOI: 10.1186/s12884-021-04329-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Plenty of studies explored the relationship between uterine artery (UtA) Doppler indices and the onset of preeclampsia at different trimesters. However, few studies test the gestational week-specific predictive value of the UtA indices for subsequent preeclampsia and compare the difference of right or left UtA indices (e.g., pulsatility or resistance index [PI or RI]). METHODS Hospital-based retrospective cohort study of singleton pregnant women who received the Doppler test between 2012 and 2016 was conducted in 2018. The predictive performance of the UtA indices for preeclampsia and its variants, including early-onset preeclampsia (< 34 weeks) and preterm preeclampsia (< 37 weeks), was estimated. RESULTS The UtA indices, with a cutoff value of 1.11 for the right and left UtA-PI, and 0.66 and 0.63 for the right and left UtA-RI, respectively, were effective predictors for subsequent preeclampsia. The prediction was satisfactory at the 9th week of the Doppler scan: areas under the curve ≥ 0.80, the Youden index ranging from 0.54 to 0.58, the sensitivity of 63.2 ~ 73.7%, and the specificity 84.2 ~ 91.3%, respectively. The UtA indices had comparable performance in screening for early-onset and preterm preeclampsia but showed lower predictive value for late-onset cases. Among these indices, the right UtA-RI had the highest specificity (all P < 0.01), while the left UtA-PI showed good authenticity (higher Youden index) in predicting the disorder. CONCLUSIONS The second-trimester measured UtA indices had a satisfactory performance at the 9th week in predicting subsequent preeclampsia. The right UtA-RI was the first choice in ruling out preeclampsia, while the left UtA-PI showed the best authenticity of the prediction.
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Affiliation(s)
- Jiang-Nan Wu
- Obstetrics and Gynecology Hospital of Fudan University, 566 Fangxie Rd, Shanghai, 200011, China.
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.
| | - Ming-Qing Li
- Obstetrics and Gynecology Hospital of Fudan University, 566 Fangxie Rd, Shanghai, 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Feng Xie
- Obstetrics and Gynecology Hospital of Fudan University, 566 Fangxie Rd, Shanghai, 200011, China.
| | - Bin Zhang
- Obstetrics and Gynecology Hospital of Fudan University, 566 Fangxie Rd, Shanghai, 200011, China
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Zheng J, Tian M, Liu L, Jia X, Sun M, Lai Y. Magnesium sulfate reduces vascular endothelial cell apoptosis in rats with preeclampsia via the miR-218-5p/HMGB1 pathway. Clin Exp Hypertens 2021; 44:159-166. [PMID: 34923889 DOI: 10.1080/10641963.2021.2013492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aims to investigate the mechanism by which magnesium sulfate regulates the miR-218-5p/HMGB-pathway-mediated apoptosis of vascular endothelial cells (VECs) in rats with preeclampsia (PE). METHODS Twenty pregnant rats were randomly divided into four groups: normal, PE, MgSO4, and high-mobility group protein B1 (HMGB1)-agomir groups. On the 14th day of each rat's pregnancy, endotoxin was used to establish a PE model in the PE, MgSO4, and HMGB1-agomir groups. Then, the MgSO4 and HMGB1-agomir groups were treated with magnesium sulfate. Finally, HMGB1 overexpression was performed only in the HMGB1-agomir group. The rats' urinary protein content and systolic blood pressure at 24 h were detected on the 11th, 13th, 15th, 17th, and 19th day of pregnancy. RESULTS Compared with the PE group, 24-h urinary protein content, blood pressure, VEC apoptosis rate, apoptosis marker levels, and HMGB1 expression decreased while miR-218-5p levels increased in the MgSO4 group. The dual-luciferase assay revealed that HMGB1 can be targeted and regulated by miR-218-5p. Compared with the MgSO4 group, 24-h urinary protein content, blood pressure, VEC apoptosis rate, apoptosis marker levels, and HMGB1 expression increased while miR-218-5p levels decreased in the HMGB1-agomir group. CONCLUSION MgSO4 reduces VEC apoptosis in PE rats via the miR-218-5p/HMGB1 pathway and thus plays a role in treating PE.
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Affiliation(s)
- Jiacui Zheng
- Department of Obstetrics, Rizhao People's Hospital Affiliated to Jining Medical Unversity, Rizhao City, Shandong, China
| | - Meirong Tian
- Department of Obstetrics, Shandong Maternal and Child Health Hospital Affiliated of Shandong, Jinan City, Shandong, China
| | - Lanlan Liu
- Department of Obstetrics, Rizhao People's Hospital Affiliated to Jining Medical Unversity, Rizhao City, Shandong, China
| | - Xueqin Jia
- Department of Obstetrics, Rizhao People's Hospital Affiliated to Jining Medical Unversity, Rizhao City, Shandong, China
| | - Meiling Sun
- Department of Obstetrics, Rizhao People's Hospital Affiliated to Jining Medical Unversity, Rizhao City, Shandong, China
| | - Yongjing Lai
- Department of Obstetrics, Rizhao People's Hospital Affiliated to Jining Medical Unversity, Rizhao City, Shandong, China
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Qing W, Shi Y, Zhou H, Chen M. Gut microbiota dysbiosis in patients with preeclampsia: A systematic review. MEDICINE IN MICROECOLOGY 2021. [DOI: 10.1016/j.medmic.2021.100047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Yoffe L, Kuperman AA, Isakov O, Haguel D, Polsky AL, Farberov L, Pillar N, Gurevich V, Haviv I, Shomron N. Assessing the involvement of the placental microbiome and virome in preeclampsia using non coding RNA sequencing. J Perinat Med 2021; 49:1071-1083. [PMID: 34114389 DOI: 10.1515/jpm-2021-0006] [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: 01/09/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Preeclampsia is a dangerous pregnancy complication. The source of preeclampsia is unknown, though the placenta is believed to have a central role in its pathogenesis. An association between maternal infection and preeclampsia has been demonstrated, yet the involvement of the placental microbiome in the etiology of preeclampsia has not been determined. In this study, we examined whether preeclampsia is associated with an imbalanced microorganism composition in the placenta. METHODS To this end, we developed a novel method for the identification of bacteria/viruses based on sequencing of small non-coding RNA, which increases the microorganism-to-host ratio, this being a major challenge in microbiome methods. We validated the method on various infected tissues and demonstrated its efficiency in detecting microorganisms in samples with extremely low bacterial/viral biomass. We then applied the method to placenta specimens from preeclamptic and healthy pregnancies. Since the placenta is a remarkably large and heterogeneous organ, we explored the bacterial and viral RNA at each of 15 distinct locations. RESULTS Bacterial RNA was detected at all locations and was consistent with previous studies of the placental microbiome, though without significant differences between the preeclampsia and control groups. Nevertheless, the bacterial RNA composition differed significantly between various areas of the placenta. Viral RNA was detected in extremely low quantities, below the threshold of significance, thus viral abundance could not be determined. CONCLUSIONS Our results suggest that the bacterial and viral abundance in the placenta may have only limited involvement in the pathogenesis of preeclampsia. The evidence of a heterogenic bacterial RNA composition in the various placental locations warrants further investigation to capture the true nature of the placental microbiome.
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Affiliation(s)
- Liron Yoffe
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir A Kuperman
- Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ofer Isakov
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine "T", Tel Aviv Medical Center, Tel Aviv, Israel
| | | | | | - Luba Farberov
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Pillar
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Izhak Haviv
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Noam Shomron
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hu J, Gao J, Liu J, Meng H, Hao N, Song Y, Ma L, Luo W, Sun J, Gao W, Meng W, Sun Y. Prospective evaluation of first-trimester screening strategy for preterm pre-eclampsia and its clinical applicability in China. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:529-539. [PMID: 33817865 DOI: 10.1002/uog.23645] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/05/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate, in a Chinese population, the performance of a screening strategy for preterm pre-eclampsia (PE) using The Fetal Medicine Foundation (FMF)'s competing-risks model and to explore its clinical applicability in mainland China. METHODS This was a prospective, multicenter, observational cohort study including 10 899 women with singleton pregnancy who sought prenatal care at one of 13 hospitals, located in seven cities in mainland China, between 1 December 2017 and 30 December 2019. Mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and maternal serum levels of placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 to 13 + 6 weeks' gestation were measured and converted into multiples of the median using Chinese reference ranges. Individualized risk for preterm PE was calculated using the FMF algorithm. Prior risk was calculated based on maternal demographic characteristics and obstetric history. We evaluated the efficiency of the screening strategy using various combinations of biomarkers and analyzed its predictive performance for a composite of placenta-associated adverse pregnancy outcomes, including PE, placental abruption, small-for-gestational age (SGA) and preterm birth, at fixed false-positive rates for preterm PE. RESULTS We identified 312 pregnancies that developed PE, of which 117 cases were diagnosed as preterm PE (< 37 weeks' gestation). There were 386 pregnancies complicated by severe composite placenta-associated adverse outcome, including preterm PE, 146 cases of severe SGA (birth weight < 3rd percentile) neonate, 61 cases with placental abruption and 109 cases of early preterm birth < 34 gestational weeks. The triple-marker model containing biomarkers MAP, UtA-PI and PAPP-A achieved, at fixed false-positive rates of 10%, 15% and 20%, detection rates for preterm PE of 65.0%, 72.7% and 76.1%, respectively, and detection rates for severe composite placenta-associated adverse outcome of 34.7%, 41.7% and 46.4%, respectively. Replacing PAPP-A with PlGF or adding PlGF to the model did not improve the performance. Of women screening positive for preterm PE at a fixed 5% false-positive rate, an estimated 30% developed at least one placenta-associated adverse pregnancy outcome, including PE, placental abruption, SGA (birth weight < 10th percentile) and preterm birth < 37 weeks. CONCLUSIONS The FMF competing-risks model for preterm PE was found to be effective in screening a mainland Chinese population. Women who screened positive for preterm PE had increased risk for other placenta-associated pregnancy complications. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Hu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China
| | - J Gao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China
| | - J Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China
| | - H Meng
- Department of Ultrasonic Diagnosis, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - N Hao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China
| | - Y Song
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China
| | - L Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China
| | - W Luo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, China
| | - J Sun
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - W Gao
- Department of Obstetrics and Gynecology, Beijing Daxing People's Hospital, Beijing, China
| | - W Meng
- Department of Obstetrics and Gynecology, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Y Sun
- Department of Obstetrics and Gynecology, Beijing Shunyi District Maternal and Child Health Hospital, Beijing, China
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The maternal blood lipidome is indicative of the pathogenesis of severe preeclampsia. J Lipid Res 2021; 62:100118. [PMID: 34547287 PMCID: PMC8503628 DOI: 10.1016/j.jlr.2021.100118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
Preeclampsia is a pregnancy-specific syndrome characterized by hypertension and proteinuria after 20 weeks of gestation. However, it is not well understood what lipids are involved in the development of this condition, and even less is known how these lipids mediate its formation. To reveal the relationship between lipids and preeclampsia, we conducted lipidomic profiling of maternal sera of 44 severe preeclamptic and 20 healthy pregnant women from a multiethnic cohort in Hawaii. Correlation network analysis showed that oxidized phospholipids have increased intercorrelations and connections in preeclampsia, whereas other lipids, including triacylglycerols, have reduced network correlations and connections. A total of 10 lipid species demonstrate significant changes uniquely associated with preeclampsia but not any other clinical confounders. These species are from the lipid classes of lysophosphatidylcholines, phosphatidylcholines (PCs), cholesteryl esters, phosphatidylethanolamines, lysophosphatidylethanolamines, and ceramides. A random forest classifier built on these lipids shows highly accurate and specific prediction (F1 statistic = 0.94; balanced accuracy = 0.88) of severe preeclampsia, demonstrating their potential as biomarkers for this condition. These lipid species are enriched in dysregulated biological pathways, including insulin signaling, immune response, and phospholipid metabolism. Moreover, causality inference shows that various PCs and lysophosphatidylcholines mediate severe preeclampsia through PC 35:1e. Our results suggest that the lipidome may play a role in the pathogenesis and serve as biomarkers of severe preeclampsia.
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El Gayed EMA, Zaid IF, El Gayed AMA, Zaki AMM, Fouda EAAM. Biochemical study on long non coding RNA gene expression in women having preeclampsia. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guarnizo-Herreño CC, Torres G, Buitrago G. Socioeconomic inequalities in birth outcomes: An 11-year analysis in Colombia. PLoS One 2021; 16:e0255150. [PMID: 34324557 PMCID: PMC8321228 DOI: 10.1371/journal.pone.0255150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/11/2021] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To examine socioeconomic inequalities in birth outcomes among infants born between 2008 and 2018 and assessed trends in inequalities during that period in Colombia, a middle-income country with high levels of inequality emerging from a long internal armed conflict. METHODS Using birth certificate data in Colombia, we analysed the outcomes of low birth weight, an Apgar score <7 at 5 minutes after birth and the number of prenatal visits among full-term pregnancies. Maternal education and health insurance schemes were used as socioeconomic position (SEP) indicators. Inequalities were estimated using the prevalence/mean of the outcomes across categories of the SEP indicators and calculating the relative and slope indices of inequality (RII and SII, respectively). RESULTS Among the 5,433,265 full-term singleton births analysed, there was a slight improvement in the outcomes analysed over the study period (lower low-birth-weight and Apgar<7 prevalence rates and higher number of prenatal visits). We observed a general pattern of social gradients and significant relative (RII) and absolute (SII) inequalities for all outcomes across both SEP indicators. RII and SII estimates with their corresponding CIs revealed a general picture of no significant changes in inequalities over time, with some particular, time-dependent exceptions. When comparing the initial and final years of our study period, inequalities in low birth weight related to maternal education increased while those in Apgar score <7 decreased. Relative inequalities across health insurance schemes increased for the two birth outcomes but decreased for the number of prenatal visits. CONCLUSION The lack of a consistent improvement in the magnitude of inequalities in birth outcomes over an 11-year period is a worrying issue because it could aggravate the cycle of inequality, given the influence of birth outcomes on health, social and economic outcomes throughout the life course. The findings of our analysis emphasize the importance of policies aimed at providing access to quality education and providing a health care system with universal coverage and high levels of integration.
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Affiliation(s)
- Carol C. Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Gabriel Torres
- Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Giancarlo Buitrago
- Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
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Abebe H, Shitu S, Workye H, Mose A. Predictors of stillbirth among women who had given birth in Southern Ethiopia, 2020: A case-control study. PLoS One 2021; 16:e0249865. [PMID: 33939713 PMCID: PMC8092801 DOI: 10.1371/journal.pone.0249865] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although the rate of stillbirth has decreased globally, it remains unacceptably high in low- and middle-income countries. Only ten countries including Ethiopia attribute more than 65% of global burden of still birth. Ethiopia has the 7th highest still birth rate in the world. Identifying the predictors of stillbirth is critical for developing successful interventions and monitoring public health programs. Although certain studies have assessed the predictors of stillbirth, they failed in identify the proximate predictors of stillbirth. In addition, the inconsistent findings in identify the predictors of stillbirth, and the methodological limitations in previously published works are some of the gaps. Therefore, this study aimed to identify the predictors of stillbirth among mothers who gave birth in six referral hospitals in Southern, Ethiopia. Methods A hospital-based unmatched case-control study was conducted in six referral hospitals in Southern, Ethiopia from October 2019 to June 2020. Consecutive sampling techniques and simple random techniques were used to recruit cases and controls respectively. A structured standard tool was used to identify the predictors of stillbirth. Data were entered into Epi Info 7 and exported to SPSS 23 for analysis. A multivariable logistic regression model was used to identify the independent predictors of stillbirth. The goodness of fit was tested using the Hosmer and Lemeshow goodness-of-fit. In this study P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study 138 stillbirth cases and 269 controls were included. Women with multiple pregnancy [AOR = 2.98, 95%CI: 1.39–6.36], having preterm birth [AOR = 2.83, 95%CI: 1.58–508], having cesarean mode of delivery [AOR = 3.19, 95%CI: 1.87–5.44], having no ANC visit [AOR = 4.17, 95%CI: 2.38–7.33], and being hypertensive during pregnancy [AOR = 3.43, 95%CI: 1.93–6.06] were significantly associated with stillbirth. Conclusions The predictors of stillbirth identified are manageable and can be amenable to interventions. Therefore, strengthening maternal antenatal care utilization should be encouraged by providing appropriate information to the mothers. There is a need to identify, screen, and critically follow high-risk mothers: those who have different complications during pregnancy, and those undergoing cesarean section due to different indications.
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Affiliation(s)
- Haimanot Abebe
- Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
- * E-mail:
| | - Solomon Shitu
- Department of Midwifery, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Haile Workye
- Department of Nursing, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Ayenew Mose
- Department of Midwifery, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
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Loh HH, Taipin H, Said A. Maternal obesity and risk of adverse obstetric outcomes in Malaysia. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:285-288. [PMID: 33855332 DOI: 10.47102/annals-acadmedsg.202054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Huai Heng Loh
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Malaysia
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Houle B, Kabudula CW, Stein A, Gareta D, Herbst K, Clark SJ. Linking the timing of a mother's and child's death: Comparative evidence from two rural South African population-based surveillance studies, 2000-2015. PLoS One 2021; 16:e0246671. [PMID: 33556118 PMCID: PMC7869981 DOI: 10.1371/journal.pone.0246671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/24/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The effect of the period before a mother's death on child survival has been assessed in only a few studies. We conducted a comparative investigation of the effect of the timing of a mother's death on child survival up to age five years in rural South Africa. METHODS We used discrete time survival analysis on data from two HIV-endemic population surveillance sites (2000-2015) to estimate a child's risk of dying before and after their mother's death. We tested if this relationship varied between sites and by availability of antiretroviral therapy (ART). We assessed if related adults in the household altered the effect of a mother's death on child survival. FINDINGS 3,618 children died from 2000-2015. The probability of a child dying began to increase in the 7-11 months prior to the mother's death and increased markedly in the 3 months before (2000-2003 relative risk = 22.2, 95% CI = 14.2-34.6) and 3 months following her death (2000-2003 RR = 20.1; CI = 10.3-39.4). This increased risk pattern was evident at both sites. The pattern attenuated with ART availability but remained even with availability at both sites. The father and maternal grandmother in the household lowered children's mortality risk independent of the association between timing of mother and child mortality. CONCLUSIONS The persistence of elevated mortality risk both before and after the mother's death for children of different ages suggests that absence of maternal care and abrupt breastfeeding cessation might be crucial risk factors. Formative research is needed to understand the circumstances for children when a mother is very ill or dies, and behavioral and other risk factors that increase both the mother and child's risk of dying. Identifying families when a mother is very ill and implementing training and support strategies for other members of the household are urgently needed to reduce preventable child mortality.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australia
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
| | - Chodziwadziwa W. Kabudula
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Stein
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Samuel J. Clark
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
- Department of Sociology, The Ohio State University, Columbus, Ohio, United States of America
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Barron A, McCarthy CM, O'Keeffe GW. Preeclampsia and Neurodevelopmental Outcomes: Potential Pathogenic Roles for Inflammation and Oxidative Stress? Mol Neurobiol 2021; 58:2734-2756. [PMID: 33492643 DOI: 10.1007/s12035-021-02290-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
Preeclampsia (PE) is a common and serious hypertensive disorder of pregnancy that occurs in approximately 3-5% of first-time pregnancies and is a well-known leading cause of maternal and neonatal mortality and morbidity. In recent years, there has been accumulating evidence that in utero exposure to PE acts as an environmental risk factor for various neurodevelopmental disorders, particularly autism spectrum disorder and ADHD. At present, the mechanism(s) mediating this relationship are uncertain. In this review, we outline the most recent evidence implicating a causal role for PE exposure in the aetiology of various neurodevelopmental disorders and provide a novel interpretation of neuroanatomical alterations in PE-exposed offspring and how these relate to their sub-optimal neurodevelopmental trajectory. We then postulate that inflammation and oxidative stress, two prominent features of the pathophysiology of PE, are likely to play a major role in mediating this association. The increased inflammation in the maternal circulation, placenta and fetal circulation in PE expose the offspring to both prenatal maternal immune activation-a risk factor for neurodevelopmental disorders, which has been well-characterised in animal models-and directly higher concentrations of pro-inflammatory cytokines, which adversely affect neuronal development. Similarly, the exaggerated oxidative stress in the mother, placenta and foetus induces the placenta to secrete factors deleterious to neurons, and exposes the fetal brain to directly elevated oxidative stress and thus adversely affects neurodevelopmental processes. Finally, we describe the interplay between inflammation and oxidative stress in PE, and how both systems interact to potentially alter neurodevelopmental trajectory in exposed offspring.
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Affiliation(s)
- Aaron Barron
- Department of Anatomy and Neuroscience, University College, Cork, Ireland.,Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Cathal M McCarthy
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland.
| | - Gerard W O'Keeffe
- Department of Anatomy and Neuroscience, University College, Cork, Ireland. .,Cork Neuroscience Centre, University College Cork, Cork, Ireland.
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Bester M, Moors S, Joshi R, Nichting TJ, van der Hout-van der Jagt MB, Oei SG, Mischi M, Vullings R, van Laar JOEH. Changes in Maternal Heart Rate Variability in Response to the Administration of Routine Obstetric Medication in Hospitalized Patients: Study Protocol for a Cohort Study (MAMA-Heart Study). Clin Pract 2021; 11:13-25. [PMID: 33599215 PMCID: PMC7838947 DOI: 10.3390/clinpract11010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/05/2022] Open
Abstract
Pregnancy is a period of continuous change in the maternal cardiovascular system, partly mediated by the autonomic nervous system. Insufficient autonomic adaptation to increasing gestation is associated with pregnancy complications, such as hypertensive disorders of pregnancy and preterm birth (both major causes of perinatal morbidity and mortality). Consequently, maternal heart rate variability (mHRV), which is a proxy measure for autonomic activity, is increasingly assessed in these cohorts to investigate the pathophysiology of their complications. A better pathophysiological understanding could facilitate the early detection of these complications, which remains challenging. However, such studies (typically performed in pregnancies leading to hospitalization) have generated conflicting findings. A probable reason for these conflicting findings is that these study cohorts were likely administered routine obstetric medications during the study period of which the effects on mHRV are largely unknown. Subsequently, we design a longitudinal, observational study to quantifying the effect of these medications-particularly corticosteroids, which are known to affect fetal HRV-on mHRV to improve the interpretation of past and future studies. We will enroll 61 women admitted to a tertiary obstetric unit with an indication to receive corticosteroids antenatally. Participants' mHRV will be continuously acquired throughout their hospitalization with wrist-worn photoplethysmography to facilitate a within-patient comparison of the effect of corticosteroids on mHRV.
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Affiliation(s)
- Maretha Bester
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Family Care Solutions, Philips Research, 5656 AE Eindhoven, The Netherlands;
| | - Suzanne Moors
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
| | - Rohan Joshi
- Department of Family Care Solutions, Philips Research, 5656 AE Eindhoven, The Netherlands;
| | - Thomas J. Nichting
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
| | - M. Beatrijs van der Hout-van der Jagt
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - S. Guid Oei
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
| | - Rik Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
| | - Judith O. E. H. van Laar
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands; (S.M.); (T.J.N.); (M.B.v.d.H.-v.d.J.); (S.G.O.); (M.M.); (R.V.); (J.O.E.H.v.L.)
- Department of Obstetrics and Gynecology, Máxima MC, 5504 DB Veldhoven, The Netherlands
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Tesema GA, Worku MG. Individual-and community-level determinants of neonatal mortality in the emerging regions of Ethiopia: a multilevel mixed-effect analysis. BMC Pregnancy Childbirth 2021; 21:12. [PMID: 33407247 PMCID: PMC7786935 DOI: 10.1186/s12884-020-03506-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 12/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Unlike infant and child mortality, neonatal mortality has declined steadily in Ethiopia. Despite the large-scale investment made by Ethiopia to improve the health of newborns and infants, it is among the regions with the highest burden of neonatal mortality. Although there are studies done on neonatal mortality in different areas of Ethiopia, as to our search of pieces of literature there is no study in Emerging regions of the country. Therefore, this study aimed to investigate the individual and community-level determinants of neonatal mortality in the Emerging regions of Ethiopia. METHODS Using the 2016 Ethiopian Demographic and Health Survey (EDHS) data, secondary data analysis was done. A total weighted sample of 4238 live births in Emerging regions were included for the final analysis. A multilevel binary logistic regression was fitted to identify the significant determinants of neonatal mortality. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV) were used for assessing the clustering effect, and deviance for model comparison. Variables with a p-value < 0.2 in the bi-variable analysis were considered in the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare statistically significant determinants of neonatal mortality. RESULTS The neonatal mortality rate in Emerging regions of Ethiopia was 34.9 per 1000 live births (95% CI: 29.8, 40.9). Being born to a mother who had no formal education (AOR = 1.79, 95% CI: 1.12, 2.88), being born to a mother who did not participate in making health care decisions (AOR = 1.25, 95% CI: 1.14, 1.79), and being twin birth (AOR = 6.85, 95% CI: 3.69, 12.70) were significantly associated with higher odds of neonatal mortality. On the other hand, being female (AOR = 0.67, 95% CI: 0.47, 0.95), having 1-3 Antenatal Care (ANC) visits (AOR = 0.34, 95% CI: 0.15, 0.74), high community media exposure (AOR = 0.64, 95% CI: 0.41, 0.98), and preceding birth interval of two to 4 years (AOR = 0.38, 95% CI: 0.24, 0.58) were significantly associated with lower odds of neonatal mortality. CONCLUSION Neonatal mortality in Emerging regions of Ethiopia was unacceptably high. Maternal education, women's autonomy in making decisions for health care, sex of a child, type of birth, preceding birth interval, ANC visit, and community media exposure were found significant determinants of neonatal mortality. Therefore, empowering women in making health care decisions and increasing access to mass media play a major role in reducing the incidence of neonatal mortality in Emerging regions of Ethiopia.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Nagalla SR, Janaki V, Vijayalakshmi AR, Chayadevi K, Pratibha D, Rao PV, Sage KM, Nair‐Schaef D, Bean E, Roberts CT, Gravett MG. Glycosylated fibronectin point-of-care test for diagnosis of pre-eclampsia in a low-resource setting: a prospective Southeast Asian population study. BJOG 2020; 127:1687-1694. [PMID: 32426899 PMCID: PMC7687275 DOI: 10.1111/1471-0528.16323] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the performance of a glycosylated fibronectin (GlyFn) point-of-care (POC) test for pre-eclampsia (PE) in a large Southeast Asian cohort (India) in comparison to previously described biomarkers. DESIGN A total of 798 pregnant women at ≥20 weeks of gestation were enrolled in a prospective case-control study. Study participants included 469 normotensive women with urinary mg protein/mmol creatinine ratio <0.3, 135 with PE (hypertension with urinary mg protein/mmol creatinine ratio ≥0.3) and 194 with gestational hypertension (hypertension with urinary mg protein/mmol creatinine ratio <0.3). METHODS GlyFn levels were determined using a POC device and PIGF, sFlt-1 and PAPPA2 levels were determined by immunoassay. Performance was assessed using logistic regression modelling and receiver-operating characteristic (ROC) curves. Classification performance and positive and negative predictive values are reported at specific thresholds. RESULTS Increased levels of GlyFn, soluble fms-like tyrosine kinase-1 (sFlt-1) and pregnancy-associated placental protein A2 (PAPPA2), and decreased levels of placental growth factor (PlGF) were significantly associated (P < 0.01) with clinically defined PE. Area under the ROC (AUROC) values with 95% confidence intervals were: GlyFn, 0.99 (0.98-0.99); PlGF, 0.96 (0.94-0.98); sFlt-1, 0.86 (0.83-0.89); and PAPPA2, 0.96 (0.94-0.97). Of subjects with GH, 48% were positive for more than two PE biomarkers, and 70% of these delivered preterm. CONCLUSIONS The Lumella™ GlyFn POC test has been validated in a low/middle-income country setting for PE diagnosis and may be a useful adjunctive tool for early identification, appropriate triage, and improved outcomes. TWEETABLE ABSTRACT The Lumella™ point-of-care test had excellent performance in diagnosing PE in a large Southeast Asian cohort.
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Affiliation(s)
| | - V Janaki
- Department of Obstetrics and GynaecologyOsmania Medical CollegeHyderabadIndia
| | - AR Vijayalakshmi
- Department of Obstetrics and GynaecologyMallareddy Institute of Medical SciencesHyderabadIndia
| | | | - D Pratibha
- Department of Obstetrics and GynaecologyOsmania Medical CollegeHyderabadIndia
| | - PV Rao
- DiabetOmics, Inc.HillsboroORUSA
| | - KM Sage
- DiabetOmics, Inc.HillsboroORUSA
| | | | - E Bean
- DiabetOmics, Inc.HillsboroORUSA
| | | | - MG Gravett
- Department of Obstetrics and GynecologyUniversity of WashingtonSeattleWAUSA
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Li L, Li H, Xue J, Chen P, Zhou Q, Zhang C. Nanoparticle-Mediated Simultaneous Downregulation of Placental Nrf2 and sFlt1 Improves Maternal and Fetal Outcomes in a Preeclampsia Mouse Model. ACS Biomater Sci Eng 2020; 6:5866-5873. [PMID: 33320575 DOI: 10.1021/acsbiomaterials.0c00826] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Preeclampsia has impacted 3-5% pregnancies among the world and its complications lead to both maternal and fetal morbidity and mortality. However, management of preeclampsia is limited. Nanoparticles targeting chondroitin sulfate A (CSA) can deliver drugs to placenta. Inactivation of soluble fms-like tyrosine kinase (sFlt-1) and nuclear factor-erythroid 2-like 2 (Nrf2) has been proved to alleviate preeclampsia and improve maternal and fetal outcomes. Carboxyl-polyethylene glycol-poly (d,l-lactide) (COOH-PEG5K-PLA8K), cationic lipid DOTAP, and siNrf2 and sisFlt-1 were used to construct the nanoparticles and conjugating peptides targeting CSA was fabricated to it. The expression levels of proteins and RNAs were estimated by qRT-PCR and Western blot assays. ELISA assays were performed to evaluate levels of circulating sFlt-1. The nanoparticles containing siNrf2 and sisFlt-1 are targeted to the placenta trophoblasts and downregulated the expression levels of Nrf2 and sFlt-1 as well as their downstream genes in the placental cells of model mice. Treatment of nanoparticles induced the expression of angiogenic factors in placenta. Knocking down Nrf2 and sFlt-1 synchronously alleviated the preeclampsia and increased the maternal and fetal outcomes in preeclampsia model mice. Nanoparticle-mediated simultaneous downregulation of placental Nrf2 and sFlt1 improved maternal and fetal outcomes in a preeclampsia mouse model.
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Affiliation(s)
- Lei Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China.,Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, Shandong 250025, China
| | - Hongyan Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Jing Xue
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Pengzheng Chen
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Qian Zhou
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Chunhua Zhang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.,Department of Obstetrics and Gynaecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
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Association between ELABELA Serum Concentrations in First Trimester and Pregnancy-Induced Hypertension. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2051701. [PMID: 33062670 PMCID: PMC7539101 DOI: 10.1155/2020/2051701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Abstract
ELABELA (ELA) is considered to be implicated in the pathophysiology of preeclampsia (PE), since ELA-deficient mice exhibited PE-like symptoms and infusion of exogenous ELA normalized the gestational hypertension (GH) and proteinuria. However, no evidence show that circulating ELA is deficient in early placental development among women who destined to develop GH/PE. This nested case-control study was conducted to investigate the association between serum ELA concentration in early pregnancy and the risk of later GH/PE. Participants were recruited and sampled in 10-14+6 weeks of gestation. Definite GH/PE cases were matched 1 : 3 to controls with respect to age and gestational age. Serum concentration of ELA was measured using enzyme immunoassay. Women with later GH (N = 28) had a slightly lower median concentration of ELA (46.72 ng/mL versus 53.54 ng/mL), while those with later PE (N = 16) had a slightly higher median concentration of ELA (74.8 ng/mL versus 66.30 ng/mL) compared to the controls. Yet, both the increments did not reach statistically significant difference (GH: P = 0.380, PE: P = 0.799). ELA serum concentrations were unchanged in first trimester in women with GH/PE. Further studies are still needed to identify the dynamic changes in serum ELA concentrations during the whole pregnancy, especially in those with pregnancy-induced hypertensive disorders.
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Tan J, Yang M, Liao Y, Qi Y, Ren Y, Liu C, Huang S, Thabane L, Liu X, Sun X. Development and validation of a prediction model on severe maternal outcomes among pregnant women with pre-eclampsia: a 10-year cohort study. Sci Rep 2020; 10:15590. [PMID: 32973289 PMCID: PMC7518280 DOI: 10.1038/s41598-020-72527-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/18/2020] [Indexed: 02/05/2023] Open
Abstract
Pre-eclampsia is a severe hypertensive disorder of pregnancy and could lead to severe maternal morbidities and death. Our study aimed to develop and validate a prognostic prediction model for severe maternal outcomes among Chinese population with pre-eclampsia. We conducted a 10-year cohort study in a referral center by collecting all pregnant women who diagnosed as pre-eclampsia and delivered from 2005 to 2014. A composite of severe maternal outcomes, including maternal near-miss defined by World Health Organization, cortical blindness/retinal detachment, temporary facial paralysis and maternal death, were adopted. We used logistic regression model to develop Model 1 by retaining the predictors of p < 0.05, and further conducted Model 2 by adding quadratic terms and interaction terms to Model 1. We undertook a bootstrapping validation and estimated the model performance. A total of 397 pregnant women suffered from severe maternal outcomes among 2,793 eligible participants, with an incidence of 14.21% (95% confidence interval (CI) 12.91%–15.51%). Of 13 predictors were finally selected in Model 1. Combined with quadratic and interactive terms, the Model 2 showed higher area under the ROC curve (82.2%, 95% CI 79.6%–84.7%) and good calibration. By the bootstrapping validation, similar model performances were present.
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Affiliation(s)
- Jing Tan
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Min Yang
- West China School of Public Health, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.,West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan, People's Republic of China.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Yuan Liao
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yana Qi
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chunrong Liu
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shiyao Huang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
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Tang J, Wang D, Lu J, Zhou X. MiR-125b participates in the occurrence of preeclampsia by regulating the migration and invasion of extravillous trophoblastic cells through STAT3 signaling pathway. J Recept Signal Transduct Res 2020; 41:202-208. [PMID: 32787544 DOI: 10.1080/10799893.2020.1806318] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Preeclampsia (PE) is a major risk factor for maternal and fetal mortality. Studies showed that microRNAs (miRNAs) play important roles in PE, and are closely related to extra-villous trophoblastic proliferation and invasion. The current study determined miR-125b expression in PE patients, and explored the role of miR-125b in the occurrence and development of PE and its possible mechanism, aiming to provide a novel basis for the diagnosis and treatment of PE. The level of miR-125b in serum derived from pregnant women was measured by quantitative real-time polymerase chain reaction (qRT-PCR). Cell proliferation, invasion and migration of HTR-8/SVneo were determined by Cell Counting Kit-8 (CCK-8), Transwell and scratch assay, respectively. The target gene of miR-125b was predicted by Targetscan, and verified by luciferase reporter assay. The expressions of related proteins were determined by Western Blotting. The miR-125b level in the serum of PE patients was up-regulated as compared with normal pregnant women, and high level of miR-125b reduced cell proliferation, inhibited invasion and migration of HTR-8/SVneo as well as the expressions of STAT3, p-STAT3 and SOCS3, while low level of miR-125b produced the opposite results. STAT3 was predicted as the target gene of miR-125b, and the high level of miR-125b inhibited STAT3 signaling pathway. High expression of miR-125b may be involved in the occurrence of PE through inhibiting STAT3 pathway to inhibit the migration and invasion of extra-villous trophoblastic cells.
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Affiliation(s)
- Jiani Tang
- Department of Obstetrics, Changzhou Second People's Hospital, Changzhou, China
| | - Dan Wang
- Department of Obstetrics, Changzhou Second People's Hospital, Changzhou, China
| | - Jing Lu
- Department of Obstetrics, Changzhou Second People's Hospital, Changzhou, China
| | - Xiaoyu Zhou
- Department of Obstetrics, Changzhou Second People's Hospital, Changzhou, China
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Zhong L, Deng W, Zheng W, Yu S, Huang X, Wen Y, Chiu PCN, Lee CL. The relationship between circadian blood pressure variability and maternal/perinatal outcomes in women with preeclampsia with severe features. Hypertens Pregnancy 2020; 39:405-410. [PMID: 32744911 DOI: 10.1080/10641955.2020.1797777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether circadian blood pressure (BP) variation of women with preeclampsia (PE) with severe features was associated with adverse maternal/perinatal outcomes. METHODS 173 women with PE with severe features were recruitedand categorized into three groups: dipper, non-dipper and reverse dipper type BP group.. Maternal and perinatal outcomes were compared among groups. RESULTS There were significant differences in gestational ages, premature delivery, retinopathy, HELLP syndrome, mean birth weight, rate of low birth weight infants and fetal growth restriction. CONCLUSION Aberrant circadian pattern of BP in women with PE with severe features was associated with several adverse maternal/perinatal outcomes.
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Affiliation(s)
- Liuying Zhong
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Wenfeng Deng
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Weihan Zheng
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Shuting Yu
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Xiaosi Huang
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Yaohong Wen
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangdong, China
| | - Philip C N Chiu
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong , Hong Kong.,Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital , Guangdong, P.R. China
| | - Cheuk-Lun Lee
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong , Hong Kong.,Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital , Guangdong, P.R. China
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Carvalho OMC, Junior ABV, Augusto MCC, Leite ÁJM, Nobre RA, Bessa OAAC, de Castro ECM, Lopes FNB, Carvalho FHC. Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study. BMC Pregnancy Childbirth 2020; 20:437. [PMID: 32727418 PMCID: PMC7391531 DOI: 10.1186/s12884-020-03128-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center. Methods This case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true “controls”), “near-miss,” and “neonatal death.” Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson’s chi-square and Fisher’s exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression. Results Comparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8–5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3–108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6–7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1–5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0–5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2–2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7–4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2–91.8). Conclusions The delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.
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Affiliation(s)
| | | | | | - Álvaro Jorge Madeiro Leite
- Departamento de Saúde Comunitária / Universidade Federal do Ceará. Fortaleza, Fortaleza, CE, Brazil.,Departamento de Saúde da Mulher, da Criança e do Adolescente UFC, Fortaleza, Brazil
| | - Rivianny Arrais Nobre
- Universidade de Fortaleza/ UNIFOR, Fortaleza, CE, Brazil.,Departamento de Saúde da Mulher, da Criança e do Adolescente UFC, Fortaleza, Brazil
| | | | | | | | - Francisco Herlânio Costa Carvalho
- Departamento de Saúde Comunitária / Universidade Federal do Ceará. Fortaleza, Fortaleza, CE, Brazil.,Departamento de Saúde da Mulher, da Criança e do Adolescente UFC, Fortaleza, Brazil.,Maternidade Escola Assis Chateaubriand, Fortaleza, CE, Brazil
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48
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Ansari N, Maruf F, Manalai P, Currie S, Soroush MS, Amin SS, Higgins-Steele A, Kim YM, Stekelenburg J, van Roosmalen J, Tappis H. Quality of care in prevention, detection and management of postpartum hemorrhage in hospitals in Afghanistan: an observational assessment. BMC Health Serv Res 2020; 20:484. [PMID: 32487154 PMCID: PMC7265625 DOI: 10.1186/s12913-020-05342-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hemorrhage is the leading cause of maternal mortality worldwide and accounts for 56% of maternal deaths in Afghanistan. Postpartum hemorrhage (PPH) is commonly caused by uterine atony, genital tract trauma, retained placenta, and coagulation disorders. The purpose of this study is to examine the quality of prevention, detection and management of PPH in both public and private hospitals in Afghanistan in 2016, and compare the quality of care in district hospitals with care in provincial, regional, and specialty hospitals. METHODS This study uses a subset of data from the 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment. It covers a census of all accessible public hospitals, including 40 district hospitals, 27 provincial hospitals, five regional hospitals, and five specialty hospitals, as well as 10 purposively selected private hospitals. RESULTS All public and private hospitals reported 24 h/7 days a week service provision. Oxytocin was available in 90.0% of district hospitals, 89.2% of provincial, regional and specialty hospitals and all 10 private hospitals; misoprostol was available in 52.5% of district hospitals, 56.8% of provincial, regional and specialty hospitals and in all 10 private hospitals. For prevention of PPH, 73.3% women in district hospitals, 71.2% women at provincial, regional and specialty hospitals and 72.7% women at private hospital received uterotonics. Placenta and membranes were checked for completeness in almost half of women in all hospitals. Manual removal of placenta was performed in 97.8% women with retained placenta. Monitoring blood loss during the immediate postpartum period was performed in 48.4% of women in district hospitals, 36.9% of women in provincial, regional and specialty hospitals, and 43.3% in private hospitals. The most commonly observed cause of PPH was retained placenta followed by genital tract trauma and uterine atony. CONCLUSION Gaps in performance of skilled birth attendants are substantial across public and private hospitals. Improving and retaining skills of health workers through on-site, continuous capacity development approaches and encouraging a culture of audit, learning and quality improvement may address clinical gaps and improve quality of PPH prevention, detection and management.
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Affiliation(s)
- Nasratullah Ansari
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
| | - Farzana Maruf
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
- Global Financing Facility, World Bank Group, Kabul, Afghanistan
| | - Partamin Manalai
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
- Jhpiego, Kabul, Afghanistan
| | | | - Mohammad Samim Soroush
- Reproductive, Maternal, Newborn, Child and Adolescent Health Department, Ministry of Public Health, Masood Square, Kabul, Afghanistan
| | | | | | | | - Jelle Stekelenburg
- University Medical Centre Groningen, Department of Health Sciences, Global Health, University of Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - Jos van Roosmalen
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands
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Li Q, Wang T, Huang S, Zuo Q, Jiang Z, Yang N, Sun L. LncRNA MALAT1 affects the migration and invasion of trophoblast cells by regulating FOS expression in early-onset preeclampsia. Pregnancy Hypertens 2020; 21:50-57. [PMID: 32408074 DOI: 10.1016/j.preghy.2020.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 03/27/2020] [Accepted: 05/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Preeclampsia (PE), particularly early-onset PE (ePE), causes maternal and fetal complications and remains a major health problem in modern society. Aberrant uterine spiral artery remodeling leads to ePE through poor placentation. In this study, we investigated the role of the long non-coding RNA (lncRNA) MALAT1 in ePE pathogenesis. METHODS Total RNA was extracted from 40 paired placental ePE tissues and control groups. RNA levels were quantified by qRT-PCR and protein expression was determined by western blotand immunohistochemistry (IHC) analysis. The effects of MALAT1 on trophoblast migration and invasion were evaluated in HTR-8/SVneo and JAR cells. FOS was identified as a downstream functional gene of MALAT1 by RNA-seq. RNA binding protein immunoprecipitations (RIPs) were performed to reveal the cellular targets of MALAT1. RESULTS MALAT1 was poorly expressed in ePE placentas and its silencing (-/-) inhibited trophoblast invasion and migration. MALAT1 -/- also decreased N-cadherin and vimentin expression, but increased E-cadherin expression. RNA-seq analysis and subsequent RIP assays showed that MALAT1 improved FOS through Hu-antigen R (HuR) binding. FOS overexpression similarly enhanced trophoblast migration and invasion. IHC staining showed that E-cadherin was upregulated in placenta tissue from ePE groups, whilst FOS, N-cadherin, and vimentin were downregulated. CONCLUSION MALAT1 promotes trophoblast migration and invasion through FOS-induced epithelial mesenchymal transition (EMT). This highlights new roles for MALAT1 in the impairment of spiral artery remodeling in ePE pathogenesis.
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Affiliation(s)
- Qin Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Tianjun Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shiyun Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Zuo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ziyan Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Nana Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lizhou Sun
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Chinkhumba J, De Allegri M, Brenner S, Muula A, Robberstad B. The cost-effectiveness of using results-based financing to reduce maternal and perinatal mortality in Malawi. BMJ Glob Health 2020; 5:e002260. [PMID: 32444363 PMCID: PMC7247376 DOI: 10.1136/bmjgh-2019-002260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/13/2020] [Accepted: 04/15/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Results-based financing (RBF) is being promoted to increase coverage and quality of maternal and perinatal healthcare in sub-Saharan Africa (SSA) countries. Evidence on the cost-effectiveness of RBF is limited. We assessed the cost-effectiveness within the context of an RBF intervention, including performance-based financing and conditional cash transfers, in rural Malawi. METHODS We used a decision tree model to estimate expected costs and effects of RBF compared with status quo care during single pregnancy episodes. RBF effects on maternal case fatality rates were modelled based on data from a maternal and perinatal programme evaluation in Zambia and Uganda. We obtained complementary epidemiological information from the published literature. Service utilisation rates for normal and complicated deliveries and associated costs of care were based on the RBF intervention in Malawi. Costs were estimated from a societal perspective. We estimated incremental cost-effectiveness ratios per disability adjusted life year (DALY) averted, death averted and life-year gained (LYG) and conducted sensitivity analyses to how robust results were to variations in key model parameters. RESULTS Relative to status quo, RBF implied incremental costs of US$1122, US$26 220 and US$987 per additional DALY averted, death averted and LYG, respectively. The share of non-RBF facilities that provide quality care, life expectancy of mothers at time of delivery and the share of births in non-RBF facilities strongly influenced cost-effectiveness values. At a willingness to pay of US$1485 (3 times Malawi gross domestic product per capita) per DALY averted, RBF has a 77% probability of being cost-effective. CONCLUSIONS At high thresholds of wiliness-to-pay, RBF is a cost-effective intervention to improve quality of maternal and perinatal healthcare and outcomes, compared with the non-RBF based approach. More RBF cost-effectiveness analyses are needed in the SSA region to complement the few published studies and narrow the uncertainties surrounding cost-effectiveness estimates.
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Affiliation(s)
- Jobiba Chinkhumba
- Department of Health Systems and Policy, Health Economics and Policy Unit, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Manuela De Allegri
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Stephan Brenner
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Adamson Muula
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Bjarne Robberstad
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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