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Arabzadeh H, Doosti-Irani A, Kamkari S, Farhadian M, Elyasi E, Mohammadi Y. The maternal factors associated with infant low birth weight: an umbrella review. BMC Pregnancy Childbirth 2024; 24:316. [PMID: 38664680 PMCID: PMC11044292 DOI: 10.1186/s12884-024-06487-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/05/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND In this umbrella review, we systematically evaluated the evidence from meta-analyses and systematic reviews of maternal factors associated with low birth weight. METHODS PubMed, Scopus, and Web of Science were searched to identify all relevant published studies up to August 2023. We included all meta-analysis studies (based on cohort, case-control, cross-sectional studies) that examined the association between maternal factors (15 risk factors) and risk of LBW, regardless of publication date. A random-effects meta-analysis was conducted to estimate the summary effect size along with the 95% confidence interval (CI), 95% prediction interval, and heterogeneity (I2) in all meta-analyses. Hedges' g was used as the effect size metric. The effects of small studies and excess significance biases were assessed using funnel plots and the Egger's test, respectively. The methodological quality of the included studies was assessed using the AMSTAR 2 tool. RESULTS We included 13 systematic Review with 15 meta-analysis studies in our study based on the inclusion criteria. The following 13 maternal factors were identified as risk factors for low birth weight: crack/cocaine (odds ratio [OR] 2.82, 95% confidence interval [CI] 2.26-3.52), infertility (OR 1.34, 95% CI 1.2-1.48), smoking (OR 2.00, 95% CI 1.76-2.28), periodontal disease (OR 2.41, 95% CI 1.67-3.47), depression (OR 1.84, 95% CI 1.34-2.53), anemia (OR 1.32, 95% CI 1.13-1.55), caffeine/coffee (OR 1.34, 95% CI 1.14-1.57), heavy physical workload (OR 1.87, 95% CI 1.00-3.47), lifting ≥ 11 kg (OR 1.59, 95% CI 1.02-2.48), underweight (OR 1.79, 95% CI 1.20-2.67), alcohol (OR 1.23, 95% CI 1.04-1.46), hypertension (OR 3.90, 95% CI 2.73-5.58), and hypothyroidism (OR 1.40, 95% CI 1.01-1.94). A significant negative association was also reported between antenatal care and low birth weight. CONCLUSIONS This umbrella review identified drug use (such as crack/cocaine), infertility, smoking, periodontal disease, depression, caffeine and anemia as risk factors for low birth weight in pregnant women. These findings suggest that pregnant women can reduce the risk of low birth weight by maintaining good oral health, eating a healthy diet, managing stress and mental health, and avoiding smoking and drug use.
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Affiliation(s)
- Hoda Arabzadeh
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sima Kamkari
- Department of Obstetrics and Gynecology, Fatemiyeh Hospital Research Center, Hamadan, Iran
| | - Maryam Farhadian
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Science, Hamadan, Iran
| | - Elahe Elyasi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Younes Mohammadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Bezie MM, Tesema GA, Seifu BL. Multilevel multinomial regression analysis of factors associated with birth weight in sub-Saharan Africa. Sci Rep 2024; 14:9210. [PMID: 38649729 PMCID: PMC11035683 DOI: 10.1038/s41598-024-58517-6] [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: 10/19/2022] [Accepted: 03/30/2024] [Indexed: 04/25/2024] Open
Abstract
Birth weight significantly determines newborns immediate and future health. Globally, the incidence of both low birth weight (LBW) and macrosomia have increased dramatically including sub-Saharan African (SSA) countries. However, there is limited study on the magnitude and associated factors of birth weight in SSA. Thus, thus study investigated factors associated factors of birth weight in SSA using multilevel multinomial logistic regression analysis. The latest demographic and health survey (DHS) data of 36 sub-Saharan African (SSA) countries was used for this study. A total of a weighted sample of 207,548 live births for whom birth weight data were available were used. Multilevel multinomial logistic regression model was fitted to identify factors associated with birth weight. Variables with p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel multinomial logistic regression analysis, the adjusted Relative Risk Ratio (aRRR) with the 95% confidence interval (CI) was reported to declare the statistical significance and strength of association. The prevalence of LBW and macrosomia in SSA were 10.44% (95% CI 10.31%, 10.57%) and 8.33% (95% CI 8.21%, 8.45%), respectively. Maternal education level, household wealth status, age, and the number of pregnancies were among the individual-level variables associated with both LBW and macrosomia in the final multilevel multinomial logistic regression analysis. The community-level factors that had a significant association with both macrosomia and LBW were the place of residence and the sub-Saharan African region. The study found a significant association between LBW and distance to the health facility, while macrosomia had a significant association with parity, marital status, and desired pregnancy. In SSA, macrosomia and LBW were found to be major public health issues. Maternal education, household wealth status, age, place of residence, number of pregnancies, distance to the health facility, and parity were found to be significant factors of LBW and macrosomia in this study. Reducing the double burden (low birth weight and macrosomia) and its related short- and long-term effects, therefore, calls for improving mothers' socioeconomic status and expanding access to and availability of health care.
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Affiliation(s)
- Meklit Melaku Bezie
- Department of Public Health, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and comprehensive specialized hospital, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Young MF, Oaks BM, Rogers HP, Tandon S, Martorell R, Dewey KG, Wendt AS. Maternal low and high hemoglobin concentrations and associations with adverse maternal and infant health outcomes: an updated global systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:264. [PMID: 37076797 PMCID: PMC10114461 DOI: 10.1186/s12884-023-05489-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/02/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Growing evidence suggests low and high maternal hemoglobin (Hb) concentrations may have adverse consequences for maternal and child health. There remain questions on specific Hb thresholds to define anemia and high Hb as well as how cutoffs may vary by anemia etiology and timing of assessment. METHODS We conducted an updated systematic review (using PubMed and Cochrane Review) on low (< 110 g/L) and high (≥ 130 g/L) maternal Hb concentrations and associations with a range of maternal and infant health outcomes. We examined associations by timing of Hb assessment (preconception; first, second, and third trimesters, as well as at any time point in pregnancy), varying cutoffs used for defining low and high hemoglobin concentrations and performed stratified analyses by iron-deficiency anemia. We conducted meta-analyses to obtain odds ratios (OR) and 95% confidence intervals. RESULTS The updated systematic review included 148 studies. Low maternal Hb at any time point in pregnancy was associated with: low birthweight, LBW (OR (95% CI) 1.28 (1.22-1.35)), very low birthweight, VLBW (2.15 (1.47-3.13)), preterm birth, PTB (1.35 (1.29-1.42)), small-for-gestational age, SGA (1.11 (1.02-1.19)), stillbirth 1.43 (1.24-1.65)), perinatal mortality (1.75 (1.28-2.39)), neonatal mortality (1.25 (1.16-1.34), postpartum hemorrhage (1.69 (1.45-1.97)), transfusion (3.68 (2.58-5.26)), pre-eclampsia (1.57 (1.23-2.01)), and prenatal depression (1.44 (1.24-1.68)). For maternal mortality, the OR was higher for Hb < 90 (4.83 (2.17-10.74)) than for Hb < 100 (2.87 (1.08-7.67)). High maternal Hb was associated with: VLBW (1.35 (1.16-1.57)), PTB (1.12 (1.00-1.25)), SGA (1.17 (1.09-1.25)), stillbirth (1.32 (1.09-1.60)), maternal mortality (2.01 (1.12-3.61)), gestational diabetes (1.71 (1.19-2.46)), and pre-eclampsia (1.34 (1.16-1.56)). Stronger associations were noted earlier in pregnancy for low Hb and adverse birth outcomes while the role of timing of high Hb was inconsistent. Lower Hb cutoffs were associated with greater odds of poor outcomes; for high Hb, data were too limited to identify patterns. Information on anemia etiology was limited; relationships did not vary by iron-deficiency anemia. CONCLUSION Both low and high maternal Hb concentrations during pregnancy are strong predictors of adverse maternal and infant health outcomes. Additional research is needed to establish healthy reference ranges and design effective interventions to optimize maternal Hb during pregnancy.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, 30322, Atlanta, GA, USA.
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, 02881, Kingston, United States
| | - Hannah Paige Rogers
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, 30322, Atlanta, GA, USA
| | - Sonia Tandon
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, 30322, Atlanta, GA, USA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, 30322, Atlanta, GA, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, 95616, Davis, United States
| | - Amanda S Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, PO Box 60 12 03, 14412,, Potsdam, Germany
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Twabi HS, Manda SO, Small DS. Assessing the effects of maternal HIV infection on pregnancy outcomes using cross-sectional data in Malawi. BMC Public Health 2020; 20:974. [PMID: 32571265 PMCID: PMC7310115 DOI: 10.1186/s12889-020-09046-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have shown that maternal HIV infection is associated with adverse pregnancy outcomes such as low birth weight and perinatal mortality. However, the association is conflicted with the effect of antiretroviral therapy (ART) on the pregnancy outcomes and it remains unexamined. If the association is confirmed then it would guide policy makers towards more effective prevention of mother to child HIV transmission interventions. Using methods for matching possible confounders, the objectives of the study were to assess the effect of maternal HIV infection on birth weight and perinatal mortality and to investigate the effect of ART on these two pregnancy outcomes in HIV-infected women. METHODS Data on 4111 and 4759 children, born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys (MDHS) respectively, whose mothers had an HIV test result, were analysed. A best balancing method was chosen from a set of covariate balance methods namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting on the PS. HIV and ART data were only available in the MDHS 2010, permitting an assessment of the moderating effect of ART on the association between maternal HIV infection and birth weight and perinatal mortality. RESULTS The overall average birth weight was 3227.9g (95% CI: 3206.4, 3249.5) in 2010 and 3226.4g (95%: 3205.6, 3247.2) in 2015-16 and perinatal mortality was 3.8% (95%: 3.2, 4.3) in 2010 and 3.5% (95%: 2.8, 3.8) in 2015-16. The prevalence of HIV among the mothers was 11.1% (95%: 10.1, 12.0) and 9.2% (95% CI: 8.4, 10.1) in 2010 and 2015-16, respectively. In 2010, maternal HIV infection was negatively associated with birth weight (mean= -25.3g, 95% CI:(-95.5, -7.4)) and in 2015-16 it was positively associated with birth weight (mean= 116.3g, 95% CI:(27.8, 204.7)). Perinatal mortality was higher in infants of HIV-infected mothers compared to infants of HIV-uninfected mothers (OR = 1.5, 95% CI:(1.1 - 3.1)) in 2010, while there was no difference in the rate in 2015-16 (OR = 1.0, 95% CI:(0.4, 1.6)). ART was not associated with birth weight, however, it was associated with perinatal mortality (OR=3.9, 95% CI:(1.1, 14.8)). CONCLUSION The study has found that maternal HIV infection had an adverse effect on birth weight and perinatal mortality in 2010. Birth weight was not dependent on ART uptake but perinatal mortality was higher among infants of HIV-infected mothers who were not on ART. The higher birth weight among HIV-infected mothers and similarity in perinatal mortality with HIV-uninfected mothers in 2015-16 may be indicative of successes of interventions within the PMTCT program in Malawi.
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Affiliation(s)
- Halima S Twabi
- Department of Mathematical Sciences, University of Malawi, Zomba, Malawi.
| | - Samuel O Manda
- Biostatistics Research Unit, South Africa Medical Research Council, Pretoria, South Africa.,School of Mathematics, Statistics and Computer Science, University of Kwazulu-Natal, Pietermaritzburg, South Africa.,Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Dylan S Small
- Department of Statistics, University of Pennyslvania, Pennyslvania, USA
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Abeywickrama G, S Padmadas S, Hinde A. Social inequalities in low birthweight outcomes in Sri Lanka: evidence from the Demographic and Health Survey 2016. BMJ Open 2020; 10:e037223. [PMID: 32457080 PMCID: PMC7252991 DOI: 10.1136/bmjopen-2020-037223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate social inequalities underlying low birthweight (LBW) outcomes in Sri Lanka. DESIGN Cross-sectional study. SETTING This study used the Sri Lanka Demographic and Health Survey 2016, the first such survey to cover the entire country since the Civil War ended in 2001. PARTICIPANTS Birthweight data extracted from the child health development records available for 7713 babies born between January 2011 and the date of interview in 2016. OUTCOME MEASURES The main outcome variable was birth weight, classified as LBW (≤2500 g) and normal. METHODS We applied random intercept three-level logistic regression to examine the association between LBW and maternal, socioeconomic and geographic variables. Concentration indices were estimated for different population subgroups. RESULTS The population-level prevalence of LBW was 16.9% but was significantly higher in the estate sector (28.4%) compared with rural (16.6%) and urban (13.6%) areas. Negative concentration indices suggest a relatively higher concentration of LBW in poor households in rural areas and the estate sector. Results from fixed effects logistic regression models confirmed our hypothesis of significantly higher risk of LBW outcomes across poorer households and Indian Tamil communities (AOR 1.70, 95% CI 1.02 to 2.83, p<0.05). Results from random intercept models confirmed there was substantial unobserved variation in LBW outcomes at the mother level. The effect of maternal biological variables was larger than that of socioeconomic factors. CONCLUSION LBW rates are significantly higher among babies born in poorer households and Indian Tamil communities. The findings highlight the need for nutrition interventions targeting pregnant women of Indian Tamil ethnicity and those living in economically deprived households.
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Affiliation(s)
- Gayathri Abeywickrama
- Department of Social Statistics and Demography, University of Southampton, Southampton, Hampshire, UK
| | - Sabu S Padmadas
- Department of Social Statistics and Demography, University of Southampton, Southampton, Hampshire, UK
- Global Health Research Institute, University of Southampton, Southampton, Hampshire, UK
| | - Andrew Hinde
- Department of Social Statistics and Demography, University of Southampton, Southampton, Hampshire, UK
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, Hampshire, UK
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NAWSHERWAN, KHAN A, BEGUM N, AHMED Z, MUBARIK S, HAQ IU, NABI G, ULLAH N, FAN C, WANG S. Low Birth Weight, and Low Ponderal Index Mediates the Association between Preeclampsia, Placenta Previa, and Neonatal Mortality. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:654-662. [PMID: 32548045 PMCID: PMC7283188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/20/2019] [Indexed: 10/31/2022]
Abstract
BACKGROUND A retrospective study was conducted to assess the mediation role of low birth weight, and low ponderal index between the preeclampsia, placenta previa, and neonatal mortality in the tertiary hospital of Hubei Province, China. METHODS A total of 12772 neonatal births were included for data analysis. Birth weight, birth length, and neonatal mortality were recorded after birth. Sobel test based on mediation regression was used to evaluate the effect of mediator variables. RESULTS Approximately, 383 (3%) and 409 (3.2%) women experienced preeclampsia and placenta previa respectively. After adjusting for covariates, the indirect effect of preeclampsia on neonatal mortality mediated by low birth weight and low ponderal index was [β 2.59 (95% CI: 0.74 - 4.44)], and [β 3.94 (95% CI: 1.50 - 6.38)] respectively. Moreover, the indirect effect of placenta previa on neonatal mortality mediated by the low birth weight was [β 1.74 (95% CI: 0.16 - 3.31)], and low ponderal index was [β 3.21 (95% CI: 0.95 - 5.48)]. The estimated mediation proportion between the preeclampsia and neonatal mortality accounting for possible mediation by low birth weight and low ponderal index was 44.5% and 34.5% respectively. Furthermore, 47.9% by low birth weight and 33.2% by low ponderal index mediate the association between placenta previa and neonatal mortality. CONCLUSION Low birth weight, and low ponderal index partially mediates the association between preeclampsia, placenta previa and neonatal mortality.
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Affiliation(s)
- NAWSHERWAN
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Abbas KHAN
- Department of Food Science, College of Food Science and Engineering, Jilin University, Changchun, China
| | - Nabila BEGUM
- Department of Advanced Innovation Center for Food Nutrition and Human Health, Laboratory of Molecular Sensory Science, College of Food and Chemical Engineering, Beijing Technology and Business University, Beijing, China
| | - Zahoor AHMED
- Department of Food Science, School of Food Science and Engineering, South China University of Technology, Guangzhou, China
| | - Sumaira MUBARIK
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Ijaz Ul HAQ
- Department of Food Science, College of Food and Pharmaceutical Science, Huaian, Jiangsu, China
| | - Ghulam NABI
- Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology of Hebei Province, College of Life Sciences, Hebei Normal University, Shijiazhuang, China
| | - Naeem ULLAH
- Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, Changchun, China
| | - Cuifang FAN
- Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Suqing WANG
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Academy for Preventive Medicine, Wuhan, Hubei, China
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Shalev Ram H, Ram S, Miller N, Rosental YS, Chodick G. Air travel during pregnancy and the risk of adverse pregnancy outcomes as gestational age and weight at birth: A retrospective study among 284,069 women in Israel between the years 2000 to 2016. PLoS One 2020; 15:e0228639. [PMID: 32027691 PMCID: PMC7004371 DOI: 10.1371/journal.pone.0228639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023] Open
Abstract
Objective The American College of Gynecology (ACOG) recommendation does not limit air travel during pregnancy, yet the evidence for air travel effect on adverse pregnancy outcomes is limited and debatable. Study objectives were to examine the association between air travel during pregnancy and preterm birth together with decreased birth weight. Study design A retrospective cohort study. Methods The study evaluated 628,292 women who gave birth to singleton infants from 9/2000 to 9/2016 and classified them into “air travel during pregnancy” or not, based on flight insurance as proxy. Multiple linear regression models were utilized to examine the relationship between air travel during pregnancy and newborn's gestational age and birth weight, while accounting for socioeconomic status, diabetes, high-risk pregnancies, and smoking. Results A total of 41,677 (6.6%) births of women who air traveled during pregnancy was included, and 586,615 (93.4%) births of women who did not. Air travel during pregnancy was associated with a statistically significant (p<0.0001) but negligible increase in birth weight (9 gr. 95% CI: 4.8 to 14.5 gr.) and gestational age (0.36 days. 95% CI: 0.24–0.48). Conclusion The study results provide no evidence that air travel during pregnancy is related to adverse effects on gestational age or birth weight. These findings corroborate the current recommendations of ACOG.
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Affiliation(s)
| | - Shai Ram
- Faculty of Medicine, Technion, Haifa, Israel
| | - Netanella Miller
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Meir Medical Center, Kfar Saba, Israel
| | | | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabi Healthcare Services, Tel Aviv, Israel Meir Medical Center, Kfar Saba, Israel
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Young MF, Oaks BM, Tandon S, Martorell R, Dewey KG, Wendt AS. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann N Y Acad Sci 2019; 1450:47-68. [PMID: 30994929 PMCID: PMC6767572 DOI: 10.1111/nyas.14093] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/05/2019] [Accepted: 03/19/2019] [Indexed: 12/14/2022]
Abstract
Maternal anemia is a well‐recognized global health problem; however, there remain questions on specific hemoglobin (Hb) thresholds that predict health risk or protection for mother and child. We conducted a systematic review and meta‐analysis to examine the associations of maternal Hb concentrations with a range of maternal and infant health outcomes, accounting for the timing of measurement (preconception, and first, second, and third trimesters), etiology of anemia, and cutoff category. The systematic review included 272 studies and the meta‐analysis included 95 studies. Low maternal Hb (<110 g/L) was associated with poor birth outcomes (low birth weight, preterm birth, small‐for‐gestational‐age (SGA), stillbirth, and perinatal and neonatal mortality) and adverse maternal outcomes (postpartum hemorrhage, preeclampsia, and blood transfusion). High maternal Hb (>130 g/L) was associated with increased odds of SGA, stillbirth, preeclampsia, and gestational diabetes. Relationships varied by the timing of measurement and cutoff category (stronger associations with lower cutoffs); limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long‐term child health outcomes. Current data are insufficient for determining if revisions to current Hb cutoffs are required. Pooled high‐quality individual‐level data analyses, as well as prospective cohort studies, would be valuable to inform the reevaluation of Hb cutoffs.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island
| | - Sonia Tandon
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | | | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, California
| | - Amanda S Wendt
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Quality antenatal care protects against low birth weight in 42 poor counties of Western China. PLoS One 2019; 14:e0210393. [PMID: 30650127 PMCID: PMC6335019 DOI: 10.1371/journal.pone.0210393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/21/2018] [Indexed: 11/03/2022] Open
Abstract
Limited data exist related to low birth weight (LBW) incidence and risk factors in Western China. This paper aims to assess LBW and its relationship with antenatal care (ANC) in the poor counties of Western China. A community-based study in rural Western China was conducted in 2011. A kernel distribution was used to estimate the adjusted LBW incidence, and associations between LBW and socio-demographic or maternal factors were examined using multilevel logistic regression. Among 8,964 participants, 65.7% were weighed at birth. Crude LBW incidence was 6.6% and the adjusted rate was 9.3%. The study revealed that risk factors of LBW are being female, raised within a minority group, and with a family income below the national poverty line. For maternal risk factors, LBW was positively associated with not attending at least five or eight ANC visits, not receiving any ANC during the first trimester, and not having access to assess certain ANC content (weight, blood pressure, blood test, urine test, B-scan ultrasound, and folic acid supplement). There is urgent need to promote quality ANC in poor and rural areas of Western China and to prioritize vulnerable women and children who will benefit from quality ANC.
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Maternal socioeconomic factors and the risk of premature birth and low birth weight in Cyprus: a case-control study. Reprod Health 2018; 15:157. [PMID: 30231873 PMCID: PMC6146509 DOI: 10.1186/s12978-018-0603-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/12/2018] [Indexed: 11/14/2022] Open
Abstract
Background Prematurity and low birth weight are significant predictors of perinatal morbidity and mortality and are influenced by the overall health and socioeconomic status of the pregnant mother. Although Cyprus is characterized by the highest prematurity rate in Europe (13.1% in 2014), the relationship between maternal health and socioeconomic characteristics with prematurity and low birth weight has never been investigated. We aimed to investigate the association of maternal demographic, clinical and socioeconomic characteristics with premature delivery and low neonatal birth weight in Cyprus. Methods In a case-control design, questionnaire data were collected from 348 women who gave birth prematurely (cases) and 349 women who gave birth at term (controls). Information was obtained on gestation duration and birth weight as well as maternal demographic, socioeconomic and clinical profiles, including parameters such as smoking, body mass index, alcohol consumption, presence of gestational diabetes and mental health factors. Results Premature delivery was associated with greater maternal age (OR: 1.12, 95% CI: 1.06–1.18), absence of gestational diabetes (OR: 0.53, 95% CI: 0.30–0.97), long working hours (OR: 3.77, 95% CI: 2.08–6.84) and emotional stress (OR: 8.5, 95% CI: 3.03–23.89). Within the cases group, emotional stress was also associated with lower birth-weight (β: -323.68 (95% CI: -570.36, − 77.00). Conclusions The findings of this study demonstrate the positive association of maternal psychological factors, working conditions as well as maternal age with prematurity and low birth weight in Cyprus. Additional, prospective, studies are needed in the country to further investigate these associations and inform public health intervention measures. Electronic supplementary material The online version of this article (10.1186/s12978-018-0603-7) contains supplementary material, which is available to authorized users.
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Figueiredo ACMG, Gomes-Filho IS, Silva RB, Pereira PPS, Mata FAFD, Lyrio AO, Souza ES, Cruz SS, Pereira MG. Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:nu10050601. [PMID: 29757207 PMCID: PMC5986481 DOI: 10.3390/nu10050601] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 01/14/2023] Open
Abstract
Objective: To systematically analyze the relationship between maternal anemia and low birth weight. Methods: A search of studies was conducted in the main databases (Medline, Embase, Scopus, Web of Science, SciELO, and Lilacs), the gray literature, and the reference lists of selected articles. Cohort and case-control studies that met the eligibility criteria were included in the review. There was no limitation on the language or date of publication. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects, subgroup analyses and meta-regressions were performed. Publication bias was measured using Egger regression and visual funnel plot inspection. Results: A total of 7243 articles were found, of which 71 comprised the systematic review and 68 were included in the meta-analyses. Maternal anemia was associated with low birth weight with an adjusted OR: 1.23 (95% CI: 1.06–1.43) and I2: 58%. The meta-regressions confirmed that the sample size and the methodological quality may partially explain the statistical heterogeneity. Conclusions: Maternal anemia was considered a risk factor for low birth weight.
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Affiliation(s)
- Ana C M G Figueiredo
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Isaac S Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana 44036-900, Bahia, Brazil.
| | - Roberta B Silva
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Priscilla P S Pereira
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Fabiana A F Da Mata
- Faculty of Medical Sciences, University of Brasilia; Brasília 70910-900, Distrito Federal, Brazil.
| | - Amanda O Lyrio
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Elivan S Souza
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Simone S Cruz
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Mauricio G Pereira
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
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Figueiredo ACMG, Gomes-Filho IS, Silva RB, Pereira PPS, Mata FAFD, Lyrio AO, Souza ES, Cruz SS, Pereira MG. Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:nu10050601. [PMID: 29757207 DOI: 10.3390/nu10050601.pmid:29757207;pmcid:pmc5986481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE To systematically analyze the relationship between maternal anemia and low birth weight. METHODS A search of studies was conducted in the main databases (Medline, Embase, Scopus, Web of Science, SciELO, and Lilacs), the gray literature, and the reference lists of selected articles. Cohort and case-control studies that met the eligibility criteria were included in the review. There was no limitation on the language or date of publication. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects, subgroup analyses and meta-regressions were performed. Publication bias was measured using Egger regression and visual funnel plot inspection. RESULTS A total of 7243 articles were found, of which 71 comprised the systematic review and 68 were included in the meta-analyses. Maternal anemia was associated with low birth weight with an adjusted OR: 1.23 (95% CI: 1.06⁻1.43) and I²: 58%. The meta-regressions confirmed that the sample size and the methodological quality may partially explain the statistical heterogeneity. CONCLUSIONS Maternal anemia was considered a risk factor for low birth weight.
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Affiliation(s)
- Ana C M G Figueiredo
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Isaac S Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana 44036-900, Bahia, Brazil.
| | - Roberta B Silva
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Priscilla P S Pereira
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
| | - Fabiana A F Da Mata
- Faculty of Medical Sciences, University of Brasilia; Brasília 70910-900, Distrito Federal, Brazil.
| | - Amanda O Lyrio
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Elivan S Souza
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Simone S Cruz
- Department of Epidemiology, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus 44.570-000, Bahia, Brazil.
| | - Mauricio G Pereira
- Faculty of Health Sciences, University of Brasilia, Brasília 70910-900, Distrito Federal, Brazil.
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Chen S, Yang Y, QV Y, Zou Y, ZHU H, Gong F, Zou Y, Yang H, WANG L, Lian BQ, Liu C, Jiang Y, Yan C, LI J, Wang Q, Pan H. Paternal exposure to medical-related radiation associated with low birthweight infants: A large population-based, retrospective cohort study in rural China. Medicine (Baltimore) 2018; 97:e9565. [PMID: 29480847 PMCID: PMC5943840 DOI: 10.1097/md.0000000000009565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Low birthweight (LBW) is closely associated with fetal and perinatal mortality and morbidity. We identified the risk factors of LBW and geographical differences in LBW incidence in 30 Chinese provinces in the present study.This study was a population-based, retrospective cohort study performed in 30 Chinese provinces. We used data from the free National Pre-pregnancy Checkups Project, which is a countrywide population-based retrospective cohort study. To identify regional differences in LBW incidence, we used the Qinling-Huaihe climate line to divide China into northern and southern sections and the Heihe-Tengchong economic line to divide it into eastern and western sections. Multivariate unconditional logistic regression analysis with SAS 9.4 was used for data analysis. P < .05 was considered statistically significant.LBW incidence was 4.54% in rural China. Southern China had a significantly higher incidence (4.65%) than northern China (4.28%). Our main risk factor for LBW is paternal exposure to radiation (odds ratio = 1.537), which has never been studied before.This study identifies multiple risk factors of couples giving birth to LBW babies including paternal risk factors.
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Affiliation(s)
- Shi Chen
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College
| | - Yingying Yang
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College
| | - Yimin QV
- School of public health, PUMC, Beijing, China
| | - Yun Zou
- The Second Hospital of Jilin University. Changchun
| | - Huijuan ZHU
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College
| | - Fengying Gong
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College
| | - Yongwei Zou
- The Stomatology Hospital of Jilin University, Jilin, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College
| | - Linjie WANG
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College
| | - Bill Q. Lian
- University of Massachusetts Medical Center, Worcester, MA
| | - Cynthia Liu
- University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KU
| | - Yu Jiang
- School of public health, PUMC, Beijing, China
| | - Chengsheng Yan
- Hebei Center for women and children's health, Shijiazhuang
| | - Jianqiang LI
- School of Software Engineering, Beijing University of Technology
| | - Qing Wang
- Tsinghua National Laboratory for Info. Science and Technology, Tsinghua University, Beijing
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College
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Dennison CA, Eslinger AJ, Reimer RA. Preconception Prebiotic and Sitagliptin Treatment in Obese Rats Affects Pregnancy Outcomes and Offspring Microbiota, Adiposity, and Glycemia. Front Endocrinol (Lausanne) 2017; 8:301. [PMID: 29163369 PMCID: PMC5670500 DOI: 10.3389/fendo.2017.00301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/16/2017] [Indexed: 01/14/2023] Open
Abstract
Maternal obesity is associated with increased risk of pregnancy complications and greater risk of obesity in offspring, but studies designed to examine preconception weight loss are limited. The objective of this study was to determine if a combined dietary [oligofructose (OFS)] and pharmacological (sitagliptin) preconception intervention could mitigate poor pregnancy outcomes associated with maternal obesity and improve offspring metabolic health and gut microbiota composition. Diet-induced obese female Sprague-Dawley rats were randomized to one of four intervention groups for 8 weeks: (1) Obese-Control (consumed control diet during intervention); (2) Obese-OFS (10% OFS diet); (3) Obese-S (sitagliptin drug); (4) Obese-OFS + S (combination treatment). Two reference groups were also included: (5) Obese-HFS (untreated obese consumed high fat/sucrose diet throughout study); (6) Lean-Control (lean reference group that were never obese and consumed control diet throughout). Offspring consumed control diet until 11 weeks of age followed by HFS diet until 17 weeks of age. The Obese-OFS + S rats lost weight during the intervention phase whereas the OFS and S treatments attenuated weight gain compared with Obese-HFS (p < 0.05). Gestational weight gain was lowest in Obese-OFS + S rats and highest in Obese-HFS rats (p < 0.05). Prepregnancy intervention did not affect reproductive parameters but did affect pregnancy outcomes including litter size. Male Obese-OFS offspring had significantly lower percent body fat than Obese-HFS at 17 weeks. Female Obese-S and Obese-OFS offspring had significantly lower fasting glucose at 17 weeks compared with Obese-Control and Obese-HFS. Clostridium cluster XI was higher in Obese-HFS and Obese-S dams at birth compared with all other groups. Dams with an adverse pregnancy outcome had significantly lower (p = 0.035) Lactobacillus spp. compared with dams with normal or small litters. At weaning, male offspring of Obese-HFS had higher levels of Methanobrevibacter than all other groups except Obese-S and female Obese-HFS offspring had higher Enterobacteriaceae compared with all other groups. At 11 and 17 weeks of age, Bacteroides/Prevotella spp. was significantly lower in male and female offspring of Obese-HFS dams compared with all other groups except Obese-OFS + S. Modest weight loss induced with a diet-drug combination did not affect maternal fecundity but did have sex-specific effects on offspring adiposity and glycemia that may be linked to changes in offspring microbiota.
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Affiliation(s)
| | - Amanda J. Eslinger
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Raylene A. Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- *Correspondence: Raylene A. Reimer,
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Sutan R, Mohtar M, Mahat AN, Tamil AM. Determinant of Low Birth Weight Infants: A Matched Case Control Study. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojpm.2014.43013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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