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Chilot D, Aragaw FM, Belay DG, Asratie MH, Bicha MM, Alem AZ. Anaemia among lactating and non-lactating women in low-income and middle-income countries: a comparative cross-sectional study. BMJ Open 2023; 13:e069851. [PMID: 37202128 DOI: 10.1136/bmjopen-2022-069851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE This study aimed to assess the prevalence and determinants of anaemia among lactating and non-lactating women in low-income and middle-income countries (LMICs). DESIGN Comparative cross-sectional study. SETTING LMICs. PARTICIPANTS Reproductive-age women. PRIMARY OUTCOME Anaemia. METHODS Data for the study were drawn from the recent 46 LMICs Demographic and Health Surveys (DHS). A total of 185 330 lactating and 827 501 non-lactating women (both are non-pregnant) who gave birth in the last 5 years preceding the survey were included. STATA V.16 was used to clean, code and analyse the data. Multilevel multivariable logistic regression was employed to identify factors associated with anaemia. In the adjusted model, the adjusted OR with 95% CI and a p value <0.05 was reported to indicate statistical association. RESULT The prevalence of anaemia among lactating and non-lactating women was found at 50.95% (95% CI 50.72, 51.17) and 49.33% (95% CI 49.23%, 49.44%), respectively. Maternal age, mother's educational status, wealth index, family size, media exposure, residence, pregnancy termination, source of drinking water and contraceptive usage were significantly associated determinants of anaemia in both lactating and non-lactating women. Additionally, the type of toilet facility, antenatal care visit, postnatal care visit, iron supplementation and place of delivery were factors significantly associated with anaemia in lactating women. Besides, smoking was significantly associated with anaemia in non-lactating women. CONCLUSIONS AND RECOMMENDATIONS The prevalence of anaemia was higher in lactating women compared with non-lactating. Almost half of the lactating and non-lactating women were anaemic. Both individual-level and community-level factors were significantly associated with anaemia. Governments, non-governmental organisations, healthcare professionals and other stakeholders are recommended to primarily focus on disadvantageous communities where their knowledge, purchasing power, access to healthcare facilities, access to clean drinking water and clean toilet facilities are minimal.
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Affiliation(s)
- Dagmawi Chilot
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
- Department of Human Physiology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Epidemology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
- Human Anatomy, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | | | - Mequanint Melesse Bicha
- Department of Gynecology and Obstetrics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Workalemahu T, Enquobahrie DA, Gelaye B, Tadesse MG, Sanchez SE, Tekola-Ayele F, Hajat A, Thornton TA, Ananth CV, Williams MA. Maternal-fetal genetic interactions, imprinting, and risk of placental abruption. J Matern Fetal Neonatal Med 2022; 35:3473-3482. [PMID: 32972274 PMCID: PMC8601203 DOI: 10.1080/14767058.2020.1822314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Abstract
RESULTS Abruption cases were more likely to experience preeclampsia, have shorter gestational age, and deliver infants with lower birthweight compared with controls. Models with MFGI effects provided improved fit than models with only maternal and fetal genotype main effects for SNP rs12530904 (p-value = 1.2e-04) in calcium/calmodulin-dependent protein kinase [CaM kinase] II beta (CAMK2B), and, SNP rs73136795 (p-value = 1.9e-04) in peroxisome proliferator-activated receptor-gamma (PPARG), both MB genes. We identified 320 SNPs in 45 maternally-imprinted genes (including potassium voltage-gated channel subfamily Q member 1 [KCNQ1], neurotrimin [NTM], and, ATPase phospholipid transporting 10 A [ATP10A]) associated with abruption. Top hits included rs2012323 (p-value = 1.6E-16) and rs12221520 (p-value1.3e-13) in KCNQ1, rs8036892 (p-value = 9.3E-17) and rs188497582 in ATP10A, rs12589854 (p-value = 2.9E-11) and rs80203467 (p-value = 4.6e-11) in maternally expressed 8, small nucleolar RNA host (MEG8), and rs138281088 in solute carrier family 22 member 2 (SLC22A2) (p-value = 6.8e-9). CONCLUSIONS We identified novel PA-related maternal-fetal MB gene interactions and imprinting effects that highlight the role of the fetus in PA risk development. Findings can inform mechanistic investigations to understand the pathogenesis of PA.
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Affiliation(s)
- Tsegaselassie Workalemahu
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Utah, Salt Lake City, Utah
| | - Daniel A. Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mahlet G. Tadesse
- Department of Mathematics and Statistics, Georgetown University, Washington, District of Columbia
| | - Sixto E. Sanchez
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru
- Asociación Civil PROESA, Lima, Peru
| | - Fasil Tekola-Ayele
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Utah, Salt Lake City, Utah
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | | | - Cande V. Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
- Cardiovascular Institute of New Jersey (CVI-NJ), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Environmental and Occupational Health Sciences Institute (EOHSI), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Jung J, Rahman MM, Rahman MS, Swe KT, Islam MR, Rahman MO, Akter S. Effects of hemoglobin levels during pregnancy on adverse maternal and infant outcomes: a systematic review and meta‐analysis. Ann N Y Acad Sci 2019; 1450:69-82. [DOI: 10.1111/nyas.14112] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/07/2019] [Accepted: 04/05/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Jenny Jung
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | - Md. Mizanur Rahman
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | - Md. Shafiur Rahman
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | - Khin Thet Swe
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
| | - Md. Rashedul Islam
- Department of Global Health Policy, School of International Healththe University of Tokyo Tokyo Japan
- Global Public Health Research Foundation Dhaka Bangladesh
| | | | - Shamima Akter
- Global Public Health Research Foundation Dhaka Bangladesh
- Department of Epidemiology and Prevention, Center for Clinical SciencesNational Center for Global Health and Medicine Tokyo Japan
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Downes KL, Shenassa ED, Grantz KL. Neonatal Outcomes Associated With Placental Abruption. Am J Epidemiol 2017; 186:1319-1328. [PMID: 28595292 DOI: 10.1093/aje/kwx202] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 03/13/2017] [Indexed: 11/13/2022] Open
Abstract
Placental abruption (early separation of the placenta) is associated with preterm birth and perinatal mortality, but associations with other neonatal morbidities remain understudied. We examined the association between abruption and newborn outcomes. We analyzed 223,341 singleton deliveries from the Consortium on Safe Labor study, a retrospective, multisite, observational study (2002-2008) of electronic medical records in the United States. Adjusted relative risks, incidence rate ratios, and 99% confidence intervals were estimated. Direct effects attributable to abruption were examined by conditioning on intermediates (preterm birth and small for gestational age) with sensitivity analyses. Incidence of abruption was 1.6% (n = 3,619). Abruption was associated with an elevated risk of newborn resuscitation (relative risk (RR) = 1.5, 99% confidence interval (CI): 1.5, 1.6), apnea (RR = 5.8, 99% CI: 5.1, 6.5), asphyxia (RR = 8.5, 99% CI: 5.7, 11.3), respiratory distress syndrome (RR = 6.5, 99% CI: 5.9, 7.1), neonatal intensive care unit admission (RR = 3.4, 99% CI: 3.2, 3.6), longer intensive care length of stay (incidence rate ratio = 2.0, 99% CI: 1.9, 2.2), stillbirth (RR = 6.3, 99% CI: 4.7, 7.9), and neonatal mortality (RR = 7.6, 99% CI: 5.2, 10.1). In sensitivity analyses, there was a direct effect of abruption associated with increased neonatal risks. These findings expand our knowledge of the association between abruption and perinatal and neonatal outcomes.
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Affiliation(s)
- Katheryne L Downes
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edmond D Shenassa
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, School of Medicine, University of Maryland, Baltimore, Maryland
- Epidemiology Department, School of Public Health, Brown University, Providence, Rhode Island
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Rejnö G, Lundholm C, Larsson K, Larsson H, Lichtenstein P, D'Onofrio BM, Saltvedt S, Almqvist C. Adverse Pregnancy Outcomes in Asthmatic Women: A Population-Based Family Design Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:916-922.e6. [PMID: 28988783 DOI: 10.1016/j.jaip.2017.07.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/08/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Asthma is associated with several adverse pregnancy and perinatal outcomes. Familial factors may confound these associations. OBJECTIVE To examine the role of measured and unmeasured confounding by conducting a study that compared differentially exposed cousins and siblings from the same families. METHODS We retrieved data on adverse pregnancy outcomes, prescribed drugs, and physician-diagnosed asthma from nationwide registers for all women in Sweden with singleton births between 2001 and 2013. Logistic and linear regression estimated the association between maternal asthma and several outcomes in the whole population and within differently exposed pregnant relatives. RESULTS In total, 1,075,153 eligible pregnancies were included and 10.1% of the study population had asthma. We identified 475,200 cousin and 341,205 sister pregnancies. Women with asthma had increased risks for preeclampsia (adjusted odds ratio [aOR], 1.17; 95% CI, 1.13-1.21), emergency cesarean section (aOR, 1.24; 95% CI, 1.22-1.27), and having a child small for gestational age (aOR, 1.18; 95% CI, 1.12-1.23). In the conditional regression analyses, after adjustment for familial factors, the associations remained: preeclampsia in cousins (aOR, 1.16; 95% CI, 1.07-1.25) and siblings (aOR, 1.23; 95% CI, 1.08-1.38), emergency cesarean section in cousins (aOR, 1.28) and siblings (aOR, 1.21), and small for gestational age in cousins (aOR, 1.17) and siblings (aOR, 1.13). CONCLUSIONS Factors shared by siblings and cousins do not seem to explain the observed association between maternal asthma and adverse pregnancy outcomes. This implies that targeting the asthma disease will continue to be important in reducing risks for adverse outcomes in pregnancy.
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Affiliation(s)
- Gustaf Rejnö
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Obstetrics & Gynaecology Unit, Södersjukhuset, Stockholm, Sweden.
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kjell Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Ind
| | - Sissel Saltvedt
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Obstetrics & Gynaecology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Unit of Pediatric Allergy and Pulmonology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Downes KL, Grantz KL, Shenassa ED. Maternal, Labor, Delivery, and Perinatal Outcomes Associated with Placental Abruption: A Systematic Review. Am J Perinatol 2017; 34:935-957. [PMID: 28329897 PMCID: PMC5683164 DOI: 10.1055/s-0037-1599149] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective Risk factors for placental abruption have changed, but there has not been an updated systematic review investigating outcomes. Methods We searched PubMed, EMBASE, Web of Science, SCOPUS, and CINAHL for publications from January 1, 2005 through December 31, 2016. We reviewed English-language publications reporting estimated incidence and/or risk factors for maternal, labor, delivery, and perinatal outcomes associated with abruption. We excluded case studies, conference abstracts, and studies that lacked a referent/comparison group or did not clearly characterize placental abruption. Results A total of 123 studies were included. Abruption was associated with elevated risk of cesarean delivery, postpartum hemorrhage and transfusion, preterm birth, intrauterine growth restriction or low birth weight, perinatal mortality, and cerebral palsy. Additional maternal outcomes included relaparotomy, hysterectomy, sepsis, amniotic fluid embolism, venous thromboembolism, acute kidney injury, and maternal intensive care unit admission. Additional perinatal outcomes included acidosis, encephalopathy, severe respiratory disorders, necrotizing enterocolitis, acute kidney injury, need for resuscitation, chronic lung disease, infant death, and epilepsy. Conclusion Few studies examined outcomes beyond the initial birth period, but there is evidence that both mother and child are at risk of additional adverse outcomes. There was also considerable variation in, or absence of, the reporting of abruption definitions.
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Affiliation(s)
- Katheryne L. Downes
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Maternal and Child Health Program, University of Maryland, College Park, Maryland
- Department of Obstetrics and Gynecology, Center for Research in Reproduction and Women’s Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine L. Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Edmond D. Shenassa
- Maternal and Child Health Program, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland
- Department of Epidemiology and Biostatistics, University of Maryland, Baltimore, Maryland
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Affiliation(s)
- Elizabeth Heavey
- Elizabeth Heavey is an associate professor of nursing at The College at Brockport, State University of New York, in Brockport, N.Y., and Mary Dahl Maher is an assistant professor of nursing at Nazareth College in Rochester, N.Y. Dr. Heavey is also a member of the Nursing2015 editorial board
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Is maternal anemia associated with small placental volume in the first trimester? Arch Gynecol Obstet 2014; 289:1207-9. [DOI: 10.1007/s00404-014-3154-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
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