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Gillespie BM, Thalib L, Ellwood D, Kang E, Mahomed K, Kumar S, Chaboyer W. Effect of negative-pressure wound therapy on wound complications in obese women after caesarean birth: a systematic review and meta-analysis. BJOG 2021; 129:196-207. [PMID: 34622545 DOI: 10.1111/1471-0528.16963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity is associated with increased surgical-site infection (SSI) following caesarean section (CS). OBJECTIVE To summarise the evidence on the effectiveness of negative-pressure wound therapy (NPWT) for preventing SSI and other wound complications in obese women after CS. SEARCH STRATEGY MEDLINE, Embase, CINAHL, Cochrane CENTRAL databases and ClinicalTrials.gov were systematically searched in March 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) of NPWT compared with standard dressings after CS birth. DATA COLLECTION AND ANALYSIS Pooled effect sizes were calculated using either fixed or random effects models based on heterogeneity. The Cochrane risk of bias and Grading of Recommendations Assessment, Development and Evaluation tools were used to assess the quality of studies and overall quality of evidence. MAIN RESULTS Ten RCTs with 5583 patients were included; studies were published between 2012 and 2021. Nine RCTs with 5529 patients were pooled for the outcome SSI. Meta-analysis results suggest a significant difference favouring the NPWT group (relative risk [RR] 0.79, 95% CI 0.65-0.95, P < 0.01), indicating an absolute risk reduction of 1.8% among those receiving NPWT compared with usual care. The risk of blistering in the NPWT group was significantly higher (RR 4.13, 95% CI 1.53-11.18, P = 0.005). All studies had high risk of bias relative to blinding of personnel/participants. Only 40% of studies reported blinding of outcome assessments and 50% had incomplete outcome data. CONCLUSIONS The decision to use NPWT should be considered both in terms of its potential benefits and its limitations. TWEETABLE ABSTRACT NPWT was associated with fewer SSI in women following CS birth but was not effective in reducing other wound complications.
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Affiliation(s)
- B M Gillespie
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University & Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
| | - L Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - D Ellwood
- Griffith University School of Medicine & Dentistry, and Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - E Kang
- Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
| | - K Mahomed
- Ipswich Hospital, Ipswich, Qld, Australia
| | - S Kumar
- Mater Research Institute, University of Queensland, Brisbane, Qld, Australia.,Mater Mothers' Hospital, South Brisbane, Qld, Australia
| | - W Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University & Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
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Flenady V, Gardener G, Ellwood D, Coory M, Weller M, Warrilow KA, Middleton PF, Wojcieszek AM, Groom KM, Boyle FM, East C, Lawford H, Callander E, Said JM, Walker SP, Mahomed K, Andrews C, Gordon A, Norman JE, Crowther C. My Baby's Movements: a stepped-wedge cluster-randomised controlled trial of a fetal movement awareness intervention to reduce stillbirths. BJOG 2021; 129:29-41. [PMID: 34555257 DOI: 10.1111/1471-0528.16944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The My Baby's Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package (the MBM intervention). DESIGN Stepped-wedge cluster-randomised controlled trial. SETTING Twenty-seven maternity hospitals in Australia and New Zealand. POPULATION Women with a singleton pregnancy without major fetal anomaly at ≥28 weeks of gestation from August 2016 to May 2019. METHODS The MBM intervention was implemented at randomly assigned time points, with the sequential introduction of eight groups of between three and five hospitals at 4-monthly intervals. Using generalised linear mixed models, the stillbirth rate was compared in the control and the intervention periods, adjusting for calendar time, study population characteristics and hospital effects. MAIN OUTCOME MEASURES Stillbirth at ≥28 weeks of gestation. RESULTS There were 304 850 births with 290 105 births meeting the inclusion criteria: 150 053 in the control and 140 052 in the intervention periods. The stillbirth rate was lower (although not statistically significantly so) during the intervention compared with the control period (2.2/1000 versus 2.4/1000 births; aOR 1.18, 95% CI 0.93-1.50; P = 0.18). The decrease in stillbirth rate was greater across calendar time: 2.7/1000 in the first versus 2.0/1000 in the last 18 months. No increase in secondary outcomes, including obstetric intervention or adverse neonatal outcome, was evident. CONCLUSIONS The MBM intervention did not reduce stillbirths beyond the downward trend over time. As a result of low uptake, the role of the intervention remains unclear, although the downward trend across time suggests some benefit in lowering the stillbirth rate. In this study setting, an awareness of the importance of fetal movements may have reached pregnant women and clinicians prior to the implementation of the intervention. TWEETABLE ABSTRACT The My Baby's Movements intervention to raise awareness of decreased fetal movement did not significantly reduce stillbirth rates.
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Affiliation(s)
- V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Department of Maternal Fetal Medicine, Mater Misericordiae Limited, Brisbane, Queensland, Australia
| | - D Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Gold Coast University Hospital, Southport, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - M Coory
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - M Weller
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - K A Warrilow
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - P F Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - A M Wojcieszek
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - F M Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - C East
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Hls Lawford
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - E Callander
- Monash University, Melbourne, Victoria, Australia
| | - J M Said
- University of Melbourne, Melbourne, Victoria, Australia.,Sunshine Hospital, Western Health, St Albans, Victoria, Australia
| | - S P Walker
- University of Melbourne, Melbourne, Victoria, Australia
| | - K Mahomed
- Ipswich Hospital, Ipswich, Queensland, Australia
| | - C Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - A Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - J E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - C Crowther
- Liggins Institute, University of Auckland, Auckland, New Zealand
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McLindon L, James G, Beckmann MM, Bertolone J, Mahomed K, Vane M, Baker T, Gleed M, Grey S, Tettamanzi L, Mol BW, Li W. O-198 Progesterone supplementation in women with threatened miscarriage: A randomised placebo-controlled clinical trial. Hum Reprod 2021. [DOI: 10.1093/humrep/deab128.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
In women with threatened miscarriage, does progesterone supplementation increase the probability of live birth?
Summary answer
In women with threatened miscarriage, 400 mg progesterone nightly, from onset of bleeding until 12 weeks, did not increase live birth rates.
What is known already
Women with a history of miscarriage who present with bleeding in early pregnancy may benefit from the use of vaginal micronized progesterone 400 mg. A recently published large randomised clinical trial indicated no overall benefit for progesterone until 16 weeks, although subgroup analysis in women with bleeding and at least one previous miscarriage, progesterone might be of benefit (Coomarasamy et al; N Engl J Med 2019;380:1815-1824).
Study design, size, duration
We performed a single centre placebo-controlled randomised clinical trial. After informed consent, women with threatened miscarriage as apparent from vaginal bleeding under 10 weeks, were randomised to 400 mg vaginal micronized progesterone or placebo. The primary endpoint was livebirth. Secondary endpoints were perinatal outcomes, including preterm birth and birthweight. The planned sample size was 386 women. At a planned interim analysis randomisation was halted at 278 women due to lack of effectiveness and slow recruitment.
Participants/materials, setting, methods
Between February 2012 and April 2019 we randomised 139 women to 400 mg vaginal micronized progesterone and 139 women to placebo. Primary outcome data are available for 134 women in the progesterone arm and 130 women in the placebo arm. Mean age was 30.7 and 30.4 years. The number of women without a previous miscarriage was 68 (51%) and 55 (42%), while 66 (49%) and 75 (58%) women had at least one previous miscarriage.
Main results and the role of chance
The live birth rates were 113/134 (84.3%) and 112/130 (86.2%), respectively (RR 0.98, 95% CI 0.89-1.08). Among women with at least 1 miscarriage live birth rates were 55/66 (83.3%) and 65/75 (86.7%) (RR 0.96, 95% CI 0.84-1.11). The number of women with more than 1 miscarriage was limited (26 vs 33 in total), but no effect was seen from progesterone in these women. Preterm birth rates were 12.9% and 9.3% (RR 1.38; 95% CI 0.69 to 2.78). There were five pregnancy losses between 20 and 23 weeks, all in the progesterone arm. Mean birth weight was 3310 vs 3300 gram (p=.99). There were also no other differences in obstetric and perinatal outcomes. Anxiety, stress and depression scores did not differ between the groups.
Limitations, reasons for caution
Our study was single centre and did not reach the planned sample size. We stopped study medication at 12 weeks which might explain the difference between our study and studies that continued progesterone till 16 weeks.
Wider implications of the findings
In women with threatened miscarriage, 400 mg vaginal progesterone did not improve live birth rates.
Trial registration number
ACTRN12611000405910
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Affiliation(s)
- L McLindon
- Mater Health, Natural Fertility Services, Brisbane, Australia
| | - G James
- Mater Health, Obstetrics and Gynaecology, Brisbane, Australia
| | - M M Beckmann
- Mater Health, Obstetrics and Gynaecology, Brisbane, Australia
| | - J Bertolone
- Mater Health, Pregnancy Assessment Centre, Brisbane, Australia
| | - K Mahomed
- Ipswich Hospital Queensland Health, Obstetrics and Gynaecology, Ipswich, Australia
| | - M Vane
- Mater Health, Natural Fertility Services, Brisbane, Australia
| | - T Baker
- Mater Health, Natural Fertility Services, Brisbane, Australia
| | - M Gleed
- Mater Health, Natural Fertility Services, Brisbane, Australia
| | - S Grey
- Mater Health, Natural Fertility Services, Brisbane, Australia
| | - L Tettamanzi
- Mater Health, Natural Fertility Services, Brisbane, Australia
| | - B W Mol
- Monash Medical Centre, Obstetrics and Gynaecology, Melbourne, Australia
| | - W Li
- Monash University, Obstetrics and Gynaecology, Melbourne, Australia
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Jamieson L, Evans D, Brennan AT, Moyo F, Spencer D, Mahomed K, Maskew M, Long L, Rosen S, Fox MP. Changes in elevated cholesterol in the era of tenofovir in South Africa: risk factors, clinical management and outcomes. HIV Med 2017; 18:595-603. [PMID: 28332270 DOI: 10.1111/hiv.12495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Antiretroviral therapy (ART) has been associated with unfavourable lipid profile changes and increased risk of cardiovascular disease (CVD). With a growing population on ART in South Africa, there has been concern about the increase in noncommunicable diseases such as CVD. We determined risk factors associated with increased total cholesterol (TC) in a large cohort on ART and describe the clinical management thereof. METHODS We conducted an observational cohort study of ART-naïve adults initiating standard first-line ART in a large urban clinic in Johannesburg, South Africa. TC was measured annually for most patients. A proportional hazards regression model was used to determine risk factors associated with incident high TC (≥ 6 mmol/L). RESULTS Significant risk factors included initial regimen non-tenofovir vs. tenofovir [hazard ratio (HR) 1.54; 95% confidence interval (CI) 1.14-2.08], age ≥40 vs. <30 years (HR 3.22; 95% CI 2.07-4.99), body mass index (BMI) ≥ 30 kg/m2 (HR 1.65; 95% CI 1.18-2.31) and BMI 25-29.9 kg/m2 (HR 1.70; 95% CI 1.30-2.23) vs. 18-24.9 kg/m2 , and baseline CD4 count < 50 cells/μL (HR 1.55; 95% CI 1.10-2.20) and 50-99 cells/μL (HR 1.40; 95% CI 1.00-1.97) vs. > 200 cells/μL. Two-thirds of patients with high TC were given cholesterol-lowering drugs, after repeat TC measurements about 12 months apart, while 31.8% were likely to have received dietary counselling only. CONCLUSIONS Older age, higher BMI, lower CD4 count and a non-tenofovir regimen were risk factors for incident elevated TC. Current guidelines do not indicate regular cholesterol testing at ART clinic visits, which are the main exposure to regular clinical monitoring for most HIV-positive individuals. If regular cholesterol monitoring is conducted, improvements can be made to identify and treat patients sooner.
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Affiliation(s)
- L Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - D Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A T Brennan
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - F Moyo
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - D Spencer
- Right to Care, Johannesburg, South Africa
| | - K Mahomed
- Right to Care, Johannesburg, South Africa
| | - M Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - L Long
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Rosen
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - M P Fox
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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5
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Mahomed K, Pungsornruk K, Gibbons K. Induction of labour for postdates in nulliparous women with uncomplicated pregnancy - is the caesarean section rate really lower? J OBSTET GYNAECOL 2016; 36:916-920. [PMID: 27612522 DOI: 10.1080/01443615.2016.1174824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Induction for "post-dates" is a very common procedure and in Queensland, Australia, accounts for 35.5% of all inductions. Systematic reviews all conclude that induction of labour does not increase the risk of caesarean section (CS). However, these reviews have generally included a mixed population and have not stratified for parity. We report in a retrospective cohort study involving only nulliparous women with uncomplicated singleton pregnancy at 40° to 416 weeks that compared to spontaneous labour, incidence of CS was significantly higher in the induction group, 22.2% versus 12.1% (OR 2.06; 95% CI 1.93-2.20) at 40° to 416 weeks versus spontaneous labour at 40° to 416 weeks; and also higher at 21.0% versus 14.9% (OR 1.52; 95% CI 1.34-1.73) at 40° to 406 weeks versus spontaneous labour at 41° to 416 weeks (expectant management).
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Affiliation(s)
- K Mahomed
- a Department of Obstetrics and Gynaecology , University of Queensland , Brisbane , QLD , Australia.,b Department of Obstetrics and Gynaecology , Ipswich Hospital , Ipswich , QLD , Australia
| | - K Pungsornruk
- a Department of Obstetrics and Gynaecology , University of Queensland , Brisbane , QLD , Australia
| | - K Gibbons
- c Mater Research Institute - The University of Queensland , South Brisbane , QLD , Australia
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Abstract
Women obtain information on epidural analgesia from various sources. For epidural for pain relief in labour this is provided by the anaesthetist as part of the consenting process. There is much discussion about the inadequacy of this consenting process; we report on women's knowledge, experience and recall of this process at a regional hospital with a 24-h epidural service. Fifty-four women were interviewed within 72 h of a vaginal birth. 91% of the women had acquired information from friends, relatives and antenatal classes. Lack of recall of benefits of epidural analgesia accounted for 26 (38%) and 25 (26%) of the responses, respectively. Similarly in terms of amount of pain relief they could expect, 13 (21%) could not remember and 13 (21%) thought that it may not work. We suggest use of varying methods of disseminating information and wider utilisation of anaesthetists in the antenatal educational programmes.
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Affiliation(s)
- K Mahomed
- a Ipswich Hospital , Ipswich , Australia.,b Department of Obstetrics and Gynecology , University of Queensland , Brisbane , Australia.,c Mater mothers Research Unit , Brisbane , Australia
| | - D Chin
- a Ipswich Hospital , Ipswich , Australia.,b Department of Obstetrics and Gynecology , University of Queensland , Brisbane , Australia
| | - A Drew
- a Ipswich Hospital , Ipswich , Australia
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7
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Mahomed K. Safe and efficient maternity services for resourced and under-resourced countries. BJOG 2014; 121:1461. [PMID: 25088566 DOI: 10.1111/1471-0528.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, Ipswich Hospital, University of Queensland, Brisbane, Qld, Australia
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Hofmeyr GJ, Nikodem VC, Mahomed K, Gülmezoĝlu AM, Lawson M, Van Der Walt LA. Obstetric short communications: Companionship to modify the clinical birth environment: no measurable effect on stress hormone levels. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619509015491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mahomed K, Williams MA, Woelk GB, Jenkins-Woelk L, Mudzamiri S, Madzime S, Sorensen TK. Risk factors for preeclampsia-eclampsia among Zimbabwean women: recurrence risk and familial tendency towards hypertension. J OBSTET GYNAECOL 2009; 18:218-22. [PMID: 15512062 DOI: 10.1080/01443619867344] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
We sought to estimate the risk of recurrence of preeclampsia-eclampsia among Zimbabwean women. Additionally, we sought to assess the extent to which family history of pregnancy-induced or chronic hypertension was predicative of the risk of developing preeclampsia-eclampsia. This hospital based case-control study was conducted at Harare Maternity Hospital, Harare Zimbabwe during the period June 1995 to April 1996. Study participants were 200 women with preeclampsia or eclampsia and 200 normotensive pregnant women serving as controls. Logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Among multiparous women, a history of any pregnancy-induced hypertension was associated with a 10.5-fold increase in risk of preeclampsia-eclampsia in a subsequent pregnancy (95% CI 4.7-23.5). Women who reported that their mother or sisters experienced pregnancy-induced hypertension were found to be at an increased risk of preeclampsia-eclampsia (OR = 2.3 and 2.6, respectively). A 2.3-fold excess risk of preeclampsia-eclampsia was associated with paturients' maternal history of chronic hypertension (95% CI 1.3-3.6). The corresponding relative risk of preeclampsia-eclampsia for women reporting to have a sister with chronic hypertension was 2.6 (95% CI 1.2-5.3). Zimbabwean women, like North American and European women, are at increased risk for the recurrence of preeclampsia-eclampsia. Findings from our study and those of others suggest a possible genetic component involved in the multifactorial aetiology of preeclampsia-eclampsia. The information provided here should be useful to clinicians involved in the management of patients with a prior history or family history of hypertension.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe, School of Medicine, Harare
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Abstract
BACKGROUND Sickle cells have a shorter life span than normal red blood cells. It has been suggested that pregnancy complications for women with sickle cell anaemia may be reduced by regular blood transfusions. The aim is to maintain haemoglobin at 60-70% of the normal total. OBJECTIVES The objective of this review was to assess the effects of a policy of routine blood transfusion for pregnant women with sickle cell disease with a policy of selective transfusion. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA Acceptably controlled trials of blood transfusion in pregnant women with sickle cell disease. DATA COLLECTION AND ANALYSIS Eligibility, trial quality assessment and data extraction were done by one reviewer. MAIN RESULTS One trial involving 72 women was included. Half the women received blood transfusion only if haemoglobin fell below 6g% and the other half received two units of blood every week for three weeks, or until haemoglobin level was 10-11g%. A policy of selective transfusion reduced the number of transfusions required at the expense of more frequent pain crises. AUTHORS' CONCLUSIONS There is not enough evidence to draw conclusions about the prophylactic use of blood transfusion for sickle cell anaemia during pregnancy.
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Affiliation(s)
- K Mahomed
- Ipswich Hospital, Ipswich, Queensland, Australia, 4305.
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Abstract
BACKGROUND Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency, malaria and other parasitic infections contribute to increased maternal and perinatal mortality and morbidity. OBJECTIVES The objective of this review was to assess the effects of iron supplementation on haematological and biochemical parameters, and on pregnancy outcome. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register was searched. Study authors were also contacted. SELECTION CRITERIA Acceptably controlled trials of iron supplementation for pregnant women. DATA COLLECTION AND ANALYSIS Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. MAIN RESULTS Twenty trials were included. Iron supplementation raised or maintained the serum ferritin above 10 milligrams per litre. It resulted in a substantial reduction of women with a haemoglobin level below 10 or 10.5 grams in late pregnancy. Iron supplementation, however, had no detectable effect on any substantive measures of either maternal or fetal outcome. One trial, with the largest number of participants of selective versus routine supplementation, showed an increased likelihood of caesarean section and post-partum blood transfusion, but a lower perinatal mortality rate (up to 7 days after birth). AUTHORS' CONCLUSIONS Iron supplementation appears to prevent low haemoglobin at birth or at six weeks post-partum. There is very little information on pregnancy outcomes for either mother or baby. There are few data derived from communities where iron deficiency is common and anaemia is a serious health problem.
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Affiliation(s)
- K Mahomed
- Ipswich Hospital, Ipswich, Queensland, Australia, 4305.
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Abstract
BACKGROUND Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency, malaria and other parasitic infections contribute to increased maternal and perinatal mortality and morbidity. OBJECTIVES The objective of this review was to assess the effects of routine iron and folate supplementation on haematological and biochemical parameters and on pregnancy outcome. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register was searched. Study authors were also contacted. SELECTION CRITERIA Acceptably controlled trials of routine iron and folate supplementation for pregnant women. DATA COLLECTION AND ANALYSIS Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. MAIN RESULTS Eight trials involving 5449 women were included. Routine supplementation with iron or folate raised or maintained the serum iron and ferritin levels and serum and red cell folate levels. Supplementation resulted in a substantial reduction of women with a haemoglobin level below 10 or 10.5 grams in late pregnancy. Routine supplementation with iron and folate had no detectable effect on any substantive measures of either maternal or fetal outcome. AUTHORS' CONCLUSIONS Routine supplementation with iron and folate appears to prevent low haemoglobin at delivery. There is very little information on other outcomes for either mother or baby. There are few data derived from communities where iron and folate deficiency is common and anaemia is a serious health problem.
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Affiliation(s)
- K Mahomed
- Ipswich Hospital, Ipswich, Queensland, Australia, 4305.
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Abstract
BACKGROUND Iodine deficiency is the leading preventable cause of intellectual impairment in the world. Although iodine supplementation is generally considered to be safe, there is a possibility of high doses of iodine suppressing maternal thyroid function. OBJECTIVES The objective of this review was to assess the effects of iodine supplementation before or during pregnancy in areas of iodine deficiency. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA All acceptably controlled trials of maternal iodine supplementation during pregnancy with clinical outcomes. DATA COLLECTION AND ANALYSIS Eligibility and trial quality were assessed by two reviewers. MAIN RESULTS Three trials involving 1551 women were included. In two trials, iodine supplementation was associated with a statistically significant reduction in deaths during infancy and early childhood (relative risk 0.71, 95% confidence interval 0.56 to 0.90). Iodine supplementation was associated with decreased prevalence of endemic cretinism at the age of four years (relative risk 0.27, 95% confidence interval 0.12 to 0.60) and better psychomotor development scores between four to 25 months of age. AUTHORS' CONCLUSIONS Iodine supplementation in a population with high levels of endemic cretinism results in an important reduction in the incidence of the condition with no apparent adverse effects.
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Affiliation(s)
- K Mahomed
- Ipswich Hospital, Ipswich, Queensland, Australia, 4305.
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Abstract
BACKGROUND Folate depletion may result in anaemia during pregnancy. OBJECTIVES The objective of this review was to assess the effects of folate supplementation in pregnancy on haematological and biochemical parameters and measures of pregnancy outcome. This review did not address the role of periconceptual folate supplementation to diminish the risk of fetal malformation. SEARCH STRATEGY A comprehensive electronic search included that of the Cochrane Pregnancy and Childbirth Group trials register. Date of last search: October 2001. SELECTION CRITERIA Acceptably controlled trials of folate supplementation compared with placebo or no treatment to pregnant women with normal haemoglobin levels. DATA COLLECTION AND ANALYSIS Trial quality was assessed. Study authors were contacted for additional information when necessary. MAIN RESULTS Twenty-one studies were included. The trials varied in quality. Compared to placebo or no supplementation, folate supplementation was associated with increased or maintained serum folate levels (odds ratio 0.18, 95% confidence interval 0.13 to 0.24) and red cell folate levels (odds ratio 0.18, 95% confidence interval 0.09 to 0.38). Folate supplementation was associated with a reduction in the proportion of women with low haemoglobin level in late pregnancy (odds ratio 0.61, 95% confidence interval 0.52 to 0.71) and megaloblastic erythropoiesis (odds ratio 0.65, 95% confidence interval 0.45 to 0.95). Apart from a possible reduction in the incidence of low birthweight, folate supplementation appears to have no measurable effect on any other substantive measures of pregnancy outcome. AUTHORS' CONCLUSIONS Folate supplementation during pregnancy appears to improve haemoglobin levels and folate status. There is not enough evidence to evaluate whether folate supplementation has any effect, beneficial or harmful, on clinical outcomes for mother and baby.
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Affiliation(s)
- K Mahomed
- Ipswich Hospital, Ipswich, Queensland, Australia, 4305.
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Abstract
BACKGROUND It has been suggested that low serum zinc levels may be associated with suboptimal outcomes of pregnancy such as prolonged labour, atonic postpartum haemorrhage, pregnancy-induced hypertension, preterm labour and post-term pregnancies, although many of these associations have not yet been established. OBJECTIVES To assess the effects of zinc supplementation in pregnancy on maternal, fetal, neonatal and infant outcomes. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2007). SELECTION CRITERIA Randomised or quasi-randomised trials of zinc supplementation in pregnancy. DATA COLLECTION AND ANALYSIS Two review authors applied the study selection criteria, assessed trial quality and extracted data. When necessary, study authors were contacted for additional information. MAIN RESULTS We included 17 randomised controlled trials (RCTs) involving over 9000 women and their babies. Zinc supplementation resulted in a small but significant reduction in preterm birth (relative risk (RR) 0.86, 95% confidence interval (CI) 0.76 to 0.98 in 13 RCTs; 6854 women). This was not accompanied by a similar reduction in numbers of babies with low birthweight (RR 1.05 95% CI 0.94 to 1.17; 11 studies of 4941 women). No significant differences were seen between the zinc and no zinc groups for any of the other primary maternal or neonatal outcomes, except for a small effect favouring zinc for caesarean section (four trials with high heterogeneity) and for induction of labour in a single trial. No differing patterns were evident in the subgroups of women with low versus normal zinc and nutrition levels or in women who complied with their treatment versus those who did not. AUTHORS' CONCLUSIONS The 14% relative reduction in preterm birth for zinc compared with placebo was primarily in the group of studies involving women of low income and this has some relevance in areas of high perinatal mortality. There was no convincing evidence that zinc supplementation during pregnancy results in other useful and important benefits. Since the preterm association could well reflect poor nutrition, studies to address ways of improving the overall nutritional status of populations in impoverished areas, rather than focusing on micronutrient and or zinc supplementation in isolation, should be an urgent priority.
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Affiliation(s)
- K Mahomed
- Ipswich Hospital, Ipswich, Queensland, Australia, 4305.
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Mahomed K, Williams MA, King IB, Mudzamiri S, Woelk GB. Erythrocyte omega-3, omega-6 and trans fatty acids in relation to risk of preeclampsia among women delivering at Harare Maternity Hospital, Zimbabwe. Physiol Res 2006; 56:37-50. [PMID: 16497090 DOI: 10.33549/physiolres.930859] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We sought to examine the association between maternal erythrocyte omega-3, omega-6 and trans fatty acids and risk of preeclampsia. We conducted a case-control study of 170 women with proteinuric, pregnancy-induced hypertension and 185 normotensive pregnant women who delivered at Harare Maternity Hospital, Harare, Zimbabwe. We measured erythrocyte omega-3, omega-6 and trans fatty acid as the percentage of total fatty acids using gas chromatography. After multivariate adjustment for confounding factors, women in the highest quartile group for total omega-3 fatty acids compared with women in the lowest quartile experienced a 14% reduction in risk of preeclampsia (odds ratio 0.86, 95% confidence interval 0.45 to 1.63). For total omega-6 fatty acids the odds ratio was 0.46 (95% confidence interval 0.23 to 0.92), although there was suggestion of a slight increase in risk of preeclampsia associated with high levels of arachidonic acid. Among women in the highest quartile for arachidonic acid the odds ratio was 1.29 (95% confidence interval 0.66 to 2.54). A strong statistically significant positive association of diunsaturated fatty acids with a trans double bond with risk of preeclampsia was observed. Women in the upper quartile of 9-cis 12-trans octadecanoic acid (C(18:2n6ct)) compared with those in the lowest quartile experienced a 3-fold higher risk of preeclampsia (odds ratio = 3.02, 95% confidence interval 1.41 to 6.45). Among women in the highest quartile for 9-trans 12-cis octadecanoic acid (C(18:2n6tc)) the odds ratio was 3.32 (95% confidence interval 1.55 to 7.13). Monounsaturated trans fatty acids were also positively associated with the risk of preeclampsia, although of much reduced magnitude. We observed a strong positive association of trans fatty acids, particularly diunsaturated trans fatty acids, with the risk of preeclampsia. We found little support for the hypothesized inverse association between omega-3 fatty acids and preeclampsia risk in this population. Polyunsaturated fatty acids, particularly omega-3 fatty acids, were comparatively lower in Zimbabwean than among US pregnant women. Given the limited inter-person variation in omega-3 fatty acids among Zimbabwean women, our sample size may be too small to adequately assess the relation in this population.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynecology, University of Zimbabwe, School of Medicine, Harare, Zimbabwe
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Makuyana D, Mawji KGD, Ndhlovu S, Munyombwe T, Majoko F, Mahomed K. Occurrence of diabetogenic changes in pregnancy among black women in an urban setting. Cent Afr J Med 2005; 51:98-102. [PMID: 17427877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To find out if pregnancy in black Zimbabwean women is a diabetogenic state using basal blood levels of cortisol, insulin, C-peptide and glucose. METHODS 111 women (28 non-pregnant, 29 first trimester, 26 second trimester and 28 third trimester) aged between 18 and 35 years were recruited for the study. Fasting plasma cortisol, insulin, C-peptide and glucose were determined by standard methods. The glucose/insulin ratio was used as an index of insulin sensitivity and the C-peptide/glucose ratio as well as the homeostasis assessment model (HOMA) as an index of insulin resistance. RESULTS The means of fasting plasma cortisol levels were significantly elevated, p < 0.0001 among the four groups (non-pregnant, first, second and third trimester women). Fasting plasma insulin levels peaked during the third trimester and significant differences were noted among all women, p < 0.05. Similar data was obtained for C-peptide levels (a better indicator of beta-cell insulin secretory activity) among the groups, p < 0.01. The means of fasting plasma glucose levels were significantly decreased with advancing gestation, p < 0.0001. Significantly lower glucose/insulin ratios, a measure of insulin sensitivity and elevated C-peptide/glucose ratios, an index of insulin resistance, were demonstrated among the women, (p < 0.05 and < 0.01 respectively). CONCLUSION The basal data presented in this paper clearly demonstrates that the diabetogenic effects of pregnancy are also expressed by Zimbabwean black women, especially in late gestation.
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Affiliation(s)
- D Makuyana
- College of Health Sciences, Department of Medical Laboratory Sciences, University of Zimbabwe (UZ), PO Box A 178 Avondale, Harare, Zimbabwe
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Mbizvo MT, Mmiro FA, Kasule J, Bagenda D, Mahomed K, Nathoo K, Mirembe F, Choto R, Nakabiito C, Ndugwa CM, Meirik O. Morbidity and mortality patterns in HIV-1 seropositive/ seronegative women in Kampala and Harare during pregnancy and in the subsequent two years. Cent Afr J Med 2005; 51:91-7. [PMID: 17427876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To compare birth outcomes, hospital admissions and mortality amongst HIV-1 seropositive and HIV-1 seronegative pregnant women in Kampala, Uganda and Harare, Zimbabwe. DESIGN In Kampala and Harare about 400 HIV-1 seropositive and 400 HIV-1 seronegative pregnant women were recruited at initial visit for antenatal care into a prospective study and followed for two years after delivery. The women were classified as HIV-1 seropositive at recruitment if initial and second ELISA tests were positive and confirmed by Western Blot assay. Data on demographic, reproductive, contraceptive and medical histories were obtained using a comprehensive questionnaire at entry, 32 and 36 weeks gestation, at delivery and at six, 12, and 24 months post delivery. In addition, a physical examination and various blood tests were performed at each antenatal and post natal visit. RESULTS During the two years after delivery, HIV-1 seropositive women had higher hospital admission and death rates than HIV-1 seronegative women. HIV-1 seropositive mothers had a two-fold increase in risk of being admitted to hospital (Kampala: RR = 2.09; 95% CI = 0.95 to 4.59; Harare: RR = 1.98; 95% CI = 1.13 to 3.45). In the six weeks after delivery eight deaths occurred, six of which were among HIV-1 seropositive women and in the period from six weeks to two years after delivery, 53 deaths occurred, 51 of which were among HIV-1 seropositive women (Kampala: RR = 17.7; 95% CI = 4.3 to 73.2; Harare: RR = 10.0; 95% CI = 2.3 to 43.1). However, there was no difference in hospital admission rates between HIV-1 seropositive and seronegative women during pregnancy itself and there was only one death during that period (in a HIV-1 seronegative woman). There was no difference in the frequency of complications of delivery between HIV-1 seropositive and HIV-1 seronegative women and the outcome of births were also similar. CONCLUSIONS A significant number of HIV-1 positive pregnant women presented at both Harare and Kampala although there was no difference in the number of hospital admissions or mortality between HIV-1 seropositive and HIV-1 seronegative women during pregnancy. Although there were no differences in complications during pregnancy or outcome at delivery, in the two years after delivery, HIV-1 seropositive women in both centres were at increased risk of being admitted to hospital and of dying.
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Affiliation(s)
- M T Mbizvo
- Department of Obstetrics and Gynaecology, University of Zimbabwe Harare, Zimbabwe
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Noble A, Ning Y, Woelk GB, Mahomed K, Williams MA. Preterm delivery risk in relation to maternal HIV infection, history of malaria and other infections among urban Zimbabwean women. Cent Afr J Med 2005; 51:53-8. [PMID: 17432432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To examine preterm delivery risk in relation to maternal HIV infection, malaria history, and other infections among Zimbabwean women. DESIGN Hospital based, cross sectional study. SETTING Harare Maternity Hospital, Harare, Zimbabwe. SUBJECTS A convenient sample of 500 pregnant women. MAIN OUTCOME MEASURE Preterm delivery. THE STUDY FACTORS: Maternal socio-demographic information, and infectious disease history (during the year before pregnancy). METHOD Between July 1998 and March 1999 data were collected for a cross sectional study of pregnant women who delivered at the Harare Maternal Hospital. The association of maternal HIV infection, history of malaria, and other infections with preterm delivery were determined using multivariate analysis. RESULTS Overall, 497 women were studied, 444 (89.3%) delivered at term and 53 women (10.7%) delivered preterm. Women who delivered preterm were less likely to be HIV seropositive compared with others (odds ratio [OR] = 0.75. 95% confidence interval (CI): 0.38 to 21.48). Preterm delivery was associated with having tuberculosis infections in the year prior to the pregnancy (OR = 10.15, 95% CI: 1.15 to 89.87). Other infections associated with preterm delivery were malaria (OR = 2.39, 95% CI: 1.07 to 5.31), chest infections (OR = 2.63, 95% CI: 0.76 to 9.17), and Herpes (shingles) infection (OR = 2.58, 95% CI: 0.56 to 11.85). Overall, a positive history of any of the non-sexually transmitted infections (in aggregate) was associated with a 3.20 fold increase risk for preterm delivery (OR = 3.20. 95% CI: 1.59 to 6.43). Women with a history of infection and who did not use iron supplements during pregnancy, compared with women without such an history and who used iron supplements, experienced the highest risk for preterm delivery (OR = 8.34, 95% CI: 3.30 to 21.07). CONCLUSION Maternal non-STD infections, (i.e., tuberculosis, malaria, and chest infections) occurring in the year prior to pregnancy were associated with an increased risk of preterm delivery. The association of non-sexually transmitted infections and preterm delivery was particularly strong among women who did not use iron supplements during pregnancy.
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Affiliation(s)
- A Noble
- Department Of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, USA
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Pham L, Woelk GB, Ning Y, Madzime S, Mudzamiri S, Mahomed K, Williams MA. Seroprevalence and risk factors of syphilis infection in pregnant women delivering at Harare Maternity Hospital, Zimbabwe. Cent Afr J Med 2005; 51:24-30. [PMID: 17892228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To evaluate risk factors and outcomes of syphilis during pregnancy. DESIGN Hospital based, cross sectional study. SETTING Harare Maternity Hospital, Harare, Zimbabwe. SUBJECTS A random sample of 2 969 pregnant women. MAIN OUTCOME MEASURES Syphilis seroprevalence. RESULTS Of the 2 969 women who provided blood samples, 4.8% were RPR positive. Approximately 2.2% of study subjects were RPR positive and TPHA negative. Notably, 2.5% of the population was RPR and TPHA positive at the time of giving birth. Older women had a higher risk of having positive syphilis status (p = 0.057). Increases in parity and gravidity were significantly associated with increased risk of syphilis infection. Prior stillbirths were associated with an increased risk of syphilis infection (odds ratio [OR], 3.4; 95% CI, 1.61 to 7.37; p = 0.001). Syphilis positive mothers were significantly more likely to give birth to syphilis positive newborns (p < 0.0001). CONCLUSIONS Our results suggest that there should be more effective antenatal screening and treatment of syphilis in Harare. Syphilis affects many sub-Saharan countries where effective educational outreach, screening, and treatment should take place to prevent the transmission of this venereal disease, especially among reproductive age and pregnant women.
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Affiliation(s)
- L Pham
- Department of Epidemiology ,University of Washington School of Public Health and Community Medicine, Seattle, USA
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Muy-Rivera M, Vadachkoria S, Woelk GB, Qiu C, Mahomed K, Williams MA. Maternal plasma VEGF, sVEGF-R1, and PlGF concentrations in preeclamptic and normotensive pregnant Zimbabwean women. Physiol Res 2005. [DOI: 10.33549/physiolres.930000.54.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Vascular endothelial growth factor (VEGF), a disulphide-linked homodimeric glycoprotein that is selectively mitogenic for endothelial cells, plays an important role in vasculogenesis and angiogenesis. Preeclampsia, a relatively common complication of pregnancy that is characterized by diffuse endothelial dysfunction possibly secondary to impaired trophoblast invasion of the spiral arteries during implantation, has recently been associated with alterations in maternal serum/plasma concentrations of VEGF, and other related growth factors and their receptors. We examined the relationship of maternal plasma VEGF, sVEGF-R1 and PlGF levels to the risk of preeclampsia among women delivering at Harare Maternity Hospital, Zimbabwe. 131 pregnant women with preeclampsia and 175 controls were included in a case-control study. Maternal plasma concentrations of each biomarker were measured using enzymatic methods. We used logistic regression to calculate odds ratios (OR) and 95 % confidence intervals (CI). Preeclampsia risk was inversely related with quartiles of plasma VEGF (OR: 1.0, 1.0, 0.7, and 0.5, with the lowest quartile as reference; p for trend = 0.06). We noted a strong positive association between preeclampsia risk and sVEGF-R1 concentrations (OR: 1.0, 6.5, 9.7, 31.6, with the first quartile as the referent group; p for trend < 0.001). After adjusting for confounders, we noted that women with sVEGF-R1 concentrations in the highest quartile (≥ 496 pg/ml), as compared with those in the lowest quartile (< 62 pg/ml) had a 31.6-fold increased risk of preeclampsia (OR = 31.6, 95 % CI 7.7-128.9). There was no clear evidence of a linear relation in risk of preeclampsia with PlGF concentrations. In conclusion, plasma VEGF, sVEGF-R1 and PlGF concentrations (measured at delivery) were altered among Zimbabwean women with preeclampsia as compared with normotensive women. Our results are consistent with some, though not all, previous reports. Prospective studies are needed to: 1) identify modifiable determinants of maternal plasma concentrations VEGF, sVEGF-R1, and PlGF; and 2) evaluate the temporal relationship between observed alterations of these biological markers in preeclamptic pregnancies.
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Muy-Rivera M, Vadachkoria S, Woelk GB, Qiu C, Mahomed K, Williams MA. Maternal plasma VEGF, sVEGF-R1, and PlGF concentrations in preeclamptic and normotensive pregnant Zimbabwean women. Physiol Res 2005; 54:611-22. [PMID: 15717861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Vascular endothelial growth factor (VEGF), a disulphide-linked homodimeric glycoprotein that is selectively mitogenic for endothelial cells, plays an important role in vasculogenesis and angiogenesis. Preeclampsia, a relatively common complication of pregnancy that is characterized by diffuse endothelial dysfunction possibly secondary to impaired trophoblast invasion of the spiral arteries during implantation, has recently been associated with alterations in maternal serum/plasma concentrations of VEGF, and other related growth factors and their receptors. We examined the relationship of maternal plasma VEGF, sVEGF-R1 and PlGF levels to the risk of preeclampsia among women delivering at Harare Maternity Hospital, Zimbabwe. 131 pregnant women with preeclampsia and 175 controls were included in a case-control study. Maternal plasma concentrations of each biomarker were measured using enzymatic methods. We used logistic regression to calculate odds ratios (OR) and 95 % confidence intervals (CI). Preeclampsia risk was inversely related with quartiles of plasma VEGF (OR: 1.0, 1.0, 0.7, and 0.5, with the lowest quartile as reference; p for trend=0.06). We noted a strong positive association between preeclampsia risk and sVEGF-R1 concentrations (OR: 1.0, 6.5, 9.7, 31.6, with the first quartile as the referent group; p for trend<0.001). After adjusting for confounders, we noted that women with sVEGF-R1 concentrations in the highest quartile (>or=496 pg/ml), as compared with those in the lowest quartile (<62 pg/ml) had a 31.6-fold increased risk of preeclampsia (OR=31.6, 95 % CI 7.7-128.9). There was no clear evidence of a linear relation in risk of preeclampsia with PlGF concentrations. In conclusion, plasma VEGF, sVEGF-R1 and PlGF concentrations (measured at delivery) were altered among Zimbabwean women with preeclampsia as compared with normotensive women. Our results are consistent with some, though not all, previous reports. Prospective studies are needed to: 1) identify modifiable determinants of maternal plasma concentrations VEGF, sVEGF-R1, and PlGF; and 2) evaluate the temporal relationship between observed alterations of these biological markers in preeclamptic pregnancies.
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Affiliation(s)
- M Muy-Rivera
- Center for Perinatal Studies, Swedish Medical Center, 747 Broadway (Suite 4 North), Seattle, WA 98122, USA
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Pena-Rosas JP, Viteri FE, Mahomed K. Oral iron supplementation with or without folic acid for women during pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd004736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nathoo K, Rusakaniko S, Zijenah LS, Kasule J, Mahomed K, Mashu A, Choto R, Mbizvo M. Survival pattern among infants born to human immunodeficiency virus type-1 infected mothers and uninfected mothers in Harare, Zimbabwe. Cent Afr J Med 2004; 50:1-6. [PMID: 15490717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVES To determine the mother-to-child transmission (MTCT) rate of HIV-1 and to compare the survival patterns among infants born to HIV-1 infected and seronegative mothers. DESIGN A two year prospective study from 1991 to 1995. METHODS 345 HIV-1 infected mothers and 351 seronegative mothers and their infants were examined at regular intervals up to 24 months of age. RESULTS The intermediate estimate of MTCT rate of HIV-1 was found to be 31.9%; (95% confidence interval (CI) 26.9 to 37.1). Of infants born to HIV-1 infected mothers 17% died compared with 2% of infants born to seronegative mothers. Forty six (43%) of the 107 HIV-1 infected infants died compared with 16 (219%) of the 559 uninfected infants. In a multivariate analysis, risk factors independently associated with infant mortality were low birth weight (hazard ratio (HR) 2.80; CI 1.52 to 5.13), HIV infected infant (HR 10.50; CI 5.48 to 20.15), HIV infected mother (HR 3.23; CI 3.17 to 15.85) and maternal death (HR 2.77; CI (1.09 to 7.06). CONCLUSION The estimated MTCT rate of HIV-1 is comparable with rates of 25% to 45% reported from the African region. The poor survival of HIV-1 infected infants indicates the necessity for effective and comprehensive HIV/AIDS control strategies in Zimbabwe.
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Affiliation(s)
- Kj Nathoo
- Department of Paediatics and Child Health, University of Zimbabwe, Medical School, PO Box A178, Avondale, Harare, Zimbabwe.
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Makuyana D, Mahomed K, Shukusho FD, Majoko F. Liver and kidney function tests in normal and pre-eclamptic gestation--a comparison with non-gestational reference values. Cent Afr J Med 2002; 48:55-9. [PMID: 12971159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To compare liver and kidney function tests in pre-eclampsia and in uncomplicated pregnancy and to relate the results to physiological reference values. DESIGN Prospective cross sectional study. SETTING Antenatal clinic and antenatal labour wards, Harare Hospital, Zimbabwe. SUBJECTS 38 pre-eclamptic and 72 normal women of similar parity, gravida and gestational age. MAIN OUTCOME MEASURES Serum albumin, total bilirubin, alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT) and gamma-glutamyl transaminase (GGT) were used as indices of hepatic function. Serum creatinine, urea and uric acid were used to assess renal function. RESULTS Albumin, bilirubin and ALT did not show any differences between the pre-eclamptic and normotensive pregnant women. The activities of the following enzymes, ALP (p < 0.001), AST (p = 0.001) and GGT (p < 0.01) were significantly elevated in pre-eclamptic women. The renal indices, creatinine, urea and uric acid were significantly raised in pre-eclampsia (p < 0.001). No significant differences were observed in the haematological parameters, haemoglobin (Hb), white blood cell count (WBC), red blood cell count (RBC), mean corpuscular volume (MCV) and platelet count. Almost all the biochemical and haematological parameters were lower in normal pregnancy compared to the physiological reference values used in our maternity unit. CONCLUSION Liver and kidney function is modified by normal pregnancy. However, the majority of the liver and kidney function tests between pre-eclamptic and normal pregnancy exhibited significant differences. The physiological reference values that are currently in use are different from those of women with uncomplicated pregnancies and may not be entirely suitable for management of pre-eclampsia which has hepatic and renal involvement.
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Affiliation(s)
- D Makuyana
- Department of Medical Laboratory Sciences, University of Zimbabwe, Medical School, Harare, Zimbabwe
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Mbizvo MT, Kasule J, Mahomed K, Nathoo K. HIV-1 seroconversion incidence following pregnancy and delivery among women seronegative at recruitment in Harare, Zimbabwe. Cent Afr J Med 2001; 47:115-8. [PMID: 11921668 DOI: 10.4314/cajm.v47i5.8600] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the incidence of HIV seroconversion among women following pregnancy and delivery. DESIGN A prospective cohort of women who were HIV negative at recruitment on first antenatal care visit. MATERIALS AND METHODS Pregnant women were invited to undergo voluntary confidential HIV counselling and blood draw for HIV testing during the first antenatal care visit as part of a prospective study of mother-to-child transmission of HIV-1. Repeat tests were conducted at delivery, six weeks post partum and at three monthly intervals until 24 months or on termination due to subsequent pregnancy, death or loss to follow up. Logistic regression modelling was used to determine independent predictors of HIV seroconversion. RESULTS Among 372 HIV negative pregnant women who were enrolled, 66 seroconverted during follow up, resulting in a sero-incidence of 4.8 per 100 person years (95% confidence interval [CI], 3.1 to 6.5). Women who did not seroconvert during the time of pregnancy or follow up were significantly more likely to have used a condom with their partners (OR = 0.68, 95% CI = 0.47 to 0.99). Women aged 17 years and below had the highest seroconversion incidence (6.25%) followed by those aged 18 to 19 years (5.42%). Women who seroconverted and those who were HIV positive at recruitment were more likely to be married. Lack of education by the partner of a pregnant woman constituted a significant risk factor for HIV seroconversion (OR = 2.8; 95% CI = 1.1 to 11.0). CONCLUSIONS There is a high HIV seroconversion incidence among women during pregnancy and following delivery, especially those aged 19 years and below. Being married does not protect the women from the risk of HIV seroconversion. Strategies for HIV prevention should target pregnant women and their partners.
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Affiliation(s)
- M T Mbizvo
- Department of Obstetrics and Gynaecology, University of Zimbabwe Medical School, Avondale, Harare, Zimbabwe.
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Galvan J, Woelk GB, Mahomed K, Wagner N, Mudzamiri S, Williams MA. Prenatal care utilization and foetal outcomes at Harare Maternity Hospital, Zimbabwe. Cent Afr J Med 2001; 47:87-92. [PMID: 11921676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
OBJECTIVES To examine the association between adverse infant outcomes and maternal under utilization of prenatal care, among women delivering at Harare Maternity Hospital. DESIGN Hospital based, cross sectional study. SETTING Harare Maternity Hospital, Harare, Zimbabwe. SUBJECTS A random sample of 3,864 pregnant women. MAIN OUTCOME MEASURES Prenatal care utilization, maternal socio-demographic information, as well as birth weight and other neonatal outcome characteristics. RESULTS Of the total number of women who participated in this study 3,491 (90%) had at least one prenatal care visit. Women receiving no prenatal care, were more likely to be younger, unmarried and to have been transferred for delivery as compared with women receiving prenatal care. Women receiving no prenatal care were seven times more likely to deliver an infant weighing less than 1,500 grams, adjusted odd ratio (OR) = 7.22; 95% confidence interval (CI) 4.58 to 11.39 as compared with those who booked for care. Newborns of unbooked mothers were more likely to have a low apgar score at birth, adjusted OR = 1.71; to have been admitted to the neonatal intensive care unit, adjusted OR = 2.14, and to require intubation, adjusted OR = 3.35. A large proportion of women (31.4%) initiated prenatal care after 30 weeks gestation. CONCLUSIONS There were significant differences between maternal characteristics and foetal outcomes in relation to booking status. Under utilization of prenatal care was associated with sub-optimal foetal outcomes. Improving the socio-economic status of women, their education and access to health care, and family planning methods are all strategies that should contribute to the reduction of adverse foetal outcomes.
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Affiliation(s)
- J Galvan
- Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, USA
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Abstract
BACKGROUND Iron deficiency is the most common cause of anaemia in pregnancy worldwide. Iron treatment can be given by mouth, intramuscular or intravenous injection. Alternatively, blood transfusions and recombinant erythropoietin are also used. OBJECTIVES To assess the effectiveness of different treatments for iron deficiency anaemia in pregnancy (defined as haemoglobin less than 11 g/dl) on maternal and neonatal morbidity and mortality. SEARCH STRATEGY Cochrane Pregnancy and Childbirth Group Specialised Register of Trial was searched. Date of last search: December 2000. SELECTION CRITERIA Randomised controlled trials comparing treatments for iron deficiency anaemia in pregnancy. DATA COLLECTION AND ANALYSIS The search identified 54 trials. Five trials, involving approximately 1234 women, met the inclusion criteria. Trial quality was assessed. Study authors were contacted for additional information. MAIN RESULTS Oral iron treatment in pregnancy was assessed in one small trial (n=125), where it was compared with placebo. This showed a reduction in the number of women with haemoglobins under 11g/dl (odds ratio (OR) 0.12, 95% confidence interval (CI) 0.06 to 0.24) and a greater mean haemoglobin level 11.3g/dl compared to 10.5 g/dl (weighted mean difference 0.80, 95% CI 0.62 to 0.98). However, there were no data on clinically relevant outcomes. When comparing different iron treatments, the intravenous (IV) route of administration was associated with an increased risk of venous thrombosis (1 trial, n=74. Iron dextran intramuscularly (IM) versus IV (n=49) OR 0.13, 95% CI 0.02-1.02. IM iron sorbitol-citric acid versus IV iron dextran, OR 0.12, 95% CI 0.02-0.94). Intravenous iron treatments were compared with placebo in one trial (n=54) but only scarce data on adverse outcomes were suitable for inclusion in this review. REVIEWER'S CONCLUSIONS This review provides inconclusive evidence on the effects of treating iron deficiency anaemia in pregnancy due to the shortage of good quality trials.
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Affiliation(s)
- L G Cuervo
- Clinical Evidence, BMJ Publishing Group, BMA House, Tavistock Square, London, UK, WC1H 9JR.
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Guevara H, Johnston E, Zijenah L, Tobaiwa O, Mason P, Contag C, Mahomed K, Hendry M, Katzenstein D. Prenatal transmission of subtype C HIV-1 in Zimbabwe: HIV-1 RNA and DNA in maternal and cord blood. J Acquir Immune Defic Syndr 2000; 25:390-7. [PMID: 11141238 DOI: 10.1097/00042560-200012150-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Maternal and cord samples from HIV-seropositive women and their infants in Zimbabwe, where subtype C is the predominant strain of HIV, were analyzed to determine the frequency of detection of HIV RNA and DNA. HIV RNA was detected in 90% of maternal and in 38% of cord plasma at levels at least 25% of maternal plasma. Heteroduplex mobility assays and sequencing of virus envelope (C2-V5) demonstrated closely related, but unique, subtype C viruses in maternal and cord RNA, and a significantly greater frequency of cord viremia among women with homogenous, compared with heterogeneous viral envelope RNA. Quantification of RNA, measures of envelope viral diversity, and phylogenetic analysis of maternal and cord plasma RNA provide evidence for the frequent exposure and potential transmission of HIV from mother to infant before birth.
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Affiliation(s)
- H Guevara
- Viral and Rickettsial Disease Laboratory, California Department of Health Services, Berkeley, USA
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Abstract
Utilization of health services is variable but may contribute to the well being of women during pregnancy. If people understand when there is a risk of illness or death, they are likely to cooperate in reducing those risks and participate in their own care. In rural communities people need to be provided with simple but scientifically-sound technology adapted to their understanding and needs. One such technology is the home-based maternal record (HBMR). We assess the feasibility, understanding and usage of a locally adapted HBMR of the World Health Organization prototype in a rural community in Binga district, Zimbabwe.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics, University of Zimbabwe, Avondale, Harare.
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Lampinen TM, Kulasingam S, Min J, Borok M, Gwanzura L, Lamb J, Mahomed K, Woelk GB, Strand KB, Bosch ML, Edelman DC, Constantine NT, Katzenstein D, Williams MA. Detection of Kaposi's sarcoma-associated herpesvirus in oral and genital secretions of Zimbabwean women. J Infect Dis 2000; 181:1785-90. [PMID: 10823785 DOI: 10.1086/315426] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/1999] [Revised: 01/14/2000] [Indexed: 11/03/2022] Open
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) in oral and genital secretions of women may be involved in horizontal and vertical transmission in endemic regions. Nested polymerase chain reaction assays were used to detect KSHV DNA sequences in one-third of oral, vaginal, and cervical specimens and in 42% of peripheral blood mononuclear cell (PBMC) specimens collected from 41 women infected with human immunodeficiency virus type 1 who had Kaposi's sarcoma (KS). KSHV DNA was not detected in specimens from 100 women without KS, 9 of whom were seropositive for KSHV. A positive association was observed between KSHV DNA detection in oral and genital mucosa, neither of which was associated with KSHV DNA detection in PBMC. These data suggest that KSHV replicates in preferred anatomic sites at levels independent of PBMC viremia. Detection of genital-tract KSHV only among relatively immunosuppressed women may provide an explanation for infrequent perinatal transmission of KSHV.
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Affiliation(s)
- T M Lampinen
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA.
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Hunter JM, Sparks BT, Mufunda J, Musabayane CT, Sparks HV, Mahomed K. Economic development and women's blood pressure: field evidence from rural Mashonaland, Zimbabwe. Soc Sci Med 2000; 50:773-95. [PMID: 10695977 DOI: 10.1016/s0277-9536(99)00303-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A survey of 515 non-pregnant women at 12 geographically chosen research sites in rural Mashonaland shows significant differences in mean blood pressure, controlled by age cohorts. Three levels of economic development are identified: (1) the traditional economy on communal lands, with lowest blood pressure, (2) the wage economy in areas of large-scale commercial agriculture, with elevated blood pressure and (3) the wage economy in mining areas, with the highest elevation of blood pressure. The area is dominated by the primate city, Harare, up to distances of 300 km and beyond, from which forces of change and modernization emanate. It is seen that potassium, sodium and the sodium potassium ratio, are distance-related to Harare and that women's blood pressures tend to follow suit. The rise of body sodium in young persons at risk, often accompanied by declining potassium intake and other changes of modernization, suggest that more attention should be focused on rural areas in Africa, now in the throes of economic change.
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Affiliation(s)
- J M Hunter
- Department of Geography, African Studies Center, Institute of International Health, Michigan State University, East Lansing 48824, USA.
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Abstract
BACKGROUND Pyridoxine (vitamin B6) contributes to the development of the central nervous system and may influence brain development and cognitive function. It may also prevent dental caries and protect the placental vascular bed. OBJECTIVES The objective of this review was to assess the effects of vitamin B6 supplementation during pregnancy and labour. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA Randomised trials of pyridoxine administration compared to a control group. DATA COLLECTION AND ANALYSIS Trial quality was assessed and data were extracted by two reviewers. MAIN RESULTS One trial involving 371 women was included. Pyridoxine supplementation either as oral capsules (odds ratio 0.63, 95% confidence interval 0. 41 to 0.95) or lozenges (odds ratio 0.33, 95% confidence interval 0. 22-0.51) was associated with decreased incidence of dental decay in pregnant women. REVIEWER'S CONCLUSIONS There is not enough evidence to evaluate pyridoxine supplementation during pregnancy, although the results of one trial suggest that it may have a beneficial effect on dental decay.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
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Abstract
BACKGROUND It has been suggested that low serum zinc levels may be associated with abnormalities of labour, although this has not yet been established. OBJECTIVES The objective of this review was to assess the effect of zinc supplementation in pregnancy on maternal and fetal mortality and morbidity. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA Acceptably controlled trials of zinc supplementation in pregnancy. DATA COLLECTION AND ANALYSIS One reviewer assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS Seven trials were included. Apart from possible reduction in induction of labour, caesarean section and preterm delivery in the supplemented group, no other differences were detected between groups of women who had zinc supplementation and those who had either placebo or no zinc during pregnancy. REVIEWER'S CONCLUSIONS There is insufficient evidence to evaluate fully the affect of zinc supplementation during pregnancy. The possible beneficial effects on preterm delivery need to be evaluated in further trials.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
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Abstract
BACKGROUND Iodine deficiency is the leading preventable cause of intellectual impairment in the world. Although iodine supplementation is generally considered to be safe, there is a possibility of high doses of iodine suppressing maternal thyroid function. OBJECTIVES The objective of this review was to assess the effects of iodine supplementation before or during pregnancy in areas of iodine deficiency. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA All acceptably controlled trials of maternal iodine supplementation during pregnancy with clinical outcomes. DATA COLLECTION AND ANALYSIS Eligibility and trial quality were assessed by two reviewers. MAIN RESULTS Three trials involving 1551 women were included. In two trials, iodine supplementation was associated with a statistically significant reduction in deaths during infancy and early childhood (relative risk 0.71, 95% confidence interval 0. 56 to 0.90). Iodine supplementation was associated with decreased prevalence of endemic cretinism at the age of four years (relative risk 0.27, 95% confidence interval 0.12 to 0.60) and better psychomotor development scores between four to 25 months of age. REVIEWER'S CONCLUSIONS Iodine supplementation in a population with high levels of endemic cretinism results in an important reduction in the incidence of the condition with no apparent adverse effects.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
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Rajkovic A, Mahomed K, Rozen R, Malinow MR, King IB, Williams MA. Methylenetetrahydrofolate reductase 677 C --> T polymorphism, plasma folate, vitamin B(12) concentrations, and risk of preeclampsia among black African women from Zimbabwe. Mol Genet Metab 2000; 69:33-9. [PMID: 10655155 DOI: 10.1006/mgme.1999.2952] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We conducted a case control study at Harare Maternity Hospital, Zimbabwe. We genotyped a total of 171 cases with preeclampsia or eclampsia and 185 normotensive control subjects for the methylenetetrahydrofolate reductase (MTHFR) 677 C --> T genotype. The wild-type allele frequency among cases and controls was 91.2 and 91.3%, respectively. Only one subject (0.3%) was homozygous for the 677 C --> T MTHFR genotype and this subject had preeclampsia. After adjustment for confounding factors, there was statistically no significant association between maternal MTHFR genotype and risk of preeclampsia (adjusted odds ratio = 1.0; 95% CI, 0.5-1.9). In addition, plasma homocyst(e)ine, vitamin B(12), and folate concentrations were not statistically different between normotensive control subjects with wild-type genotype as compared with normotensive subjects who were heterozygous for the mutant allele. Conversely, there was a strong graded association between maternal plasma folate concentration and risk of preeclampsia. Women with plasma folate concentrations less than 5.7 nmol/L experienced a 10. 4-fold increase in risk of preeclampsia. There was no clear pattern of preeclampsia risk and vitamin B(12) concentrations.
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Affiliation(s)
- A Rajkovic
- Departments of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, 77030, USA.
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41
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Abstract
BACKGROUND Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency, malaria and other parasitic infections contribute to increased maternal and perinatal mortality and morbidity. OBJECTIVES The objective of this review was to assess the effects of routine iron and folate supplementation on haematological and biochemical parameters and on pregnancy outcome. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register was searched. Study authors were also contacted. SELECTION CRITERIA Acceptably controlled trials of routine iron and folate supplementation for pregnant women. DATA COLLECTION AND ANALYSIS Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. MAIN RESULTS Eight trials involving 5449 women were included. Routine supplementation with iron or folate raised or maintained the serum iron and ferritin levels and serum and red cell folate levels. Supplementation resulted in a substantial reduction of women with a haemoglobin level below 10 or 10.5 grams in late pregnancy. Routine supplementation with iron and folate had no detectable effect on any substantive measures of either maternal or fetal outcome. REVIEWER'S CONCLUSIONS Routine supplementation with iron and folate appears to prevent low haemoglobin at delivery. There is very little information on other outcomes for either mother or baby. There are few data derived from communities where iron and folate deficiency is common and anaemia is a serious health problem.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
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42
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Abstract
BACKGROUND Anaemia in pregnancy is a major health problem in many developing countries where nutritional deficiency, malaria and other parasitic infections contribute to increased maternal and perinatal mortality and morbidity. OBJECTIVES The objective of this review was to assess the effects of iron supplementation on haematological and biochemical parameters, and on pregnancy outcome. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register was searched. Study authors were also contacted. SELECTION CRITERIA Acceptably controlled trials of iron supplementation for pregnant women. DATA COLLECTION AND ANALYSIS Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. MAIN RESULTS Twenty trials were included. Iron supplementation raised or maintained the serum ferritin above 10 milligrams per litre. It resulted in a substantial reduction of women with a haemoglobin level below 10 or 10.5 grams in late pregnancy. Iron supplementation, however, had no detectable effect on any substantive measures of either maternal or fetal outcome. One trial, with the largest number of participants of selective versus routine supplementation, showed an increased likelihood of caesarean section and post-partum blood transfusion, but a lower perinatal mortality rate (up to 7 days after birth). REVIEWER'S CONCLUSIONS Iron supplementation appears to prevent low haemoglobin at birth or at six weeks post-partum. There is very little information on pregnancy outcomes for either mother or baby. There are few data derived from communities where iron deficiency is common and anaemia is a serious health problem.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
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Abstract
BACKGROUND Vitamin D deficiency can occur in people whose diet is relatively low in the vitamin and those who are not exposed to much sunlight. OBJECTIVES The objective of this review was to assess the effects of vitamin D supplementation on pregnancy outcome. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (October 1998). SELECTION CRITERIA Acceptably controlled trials of vitamin D supplementation during pregnancy. DATA COLLECTION AND ANALYSIS One reviewer assessed trial quality and extracted data. MAIN RESULTS Two trials involving 232 women were included. In one trial the mothers had higher mean daily weight gain and lower number of low birthweight infants. In the other trial the supplemented group had lower birthweights. REVIEWER'S CONCLUSIONS There is not enough evidence to evaluate the effects of vitamin D supplementation during pregnancy.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
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Mahomed K, Williams MA, Woelk GB, Mudzamiri S, Madzime S, King IB, Bankson DD. Leukocyte selenium, zinc, and copper concentrations in preeclamptic and normotensive pregnant women. Biol Trace Elem Res 2000; 75:107-18. [PMID: 11051601 DOI: 10.1385/bter:75:1-3:107] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/1999] [Revised: 09/17/1999] [Accepted: 09/20/1999] [Indexed: 11/11/2022]
Abstract
Preeclampsia is an important cause of maternal and perinatal mortality worldwide. The etiology of this relatively common medical complication of pregnancy, however, remains unknown. We studied the relationship between maternal leukocyte selenium, zinc, and copper concentrations and the risk of preeclampsia in a large hospital-based case-control study. One hundred seventy-one women with proteinuric pregnancy-induced hypertension (with or without seizures) comprised the case group. Controls were 184 normotensive pregnant women. Leukocytes were separated from blood samples collected during the patients' postpartum labor and delivery admission. Leukocyte concentrations for the three cations were measured by inductively coupled plasma-mass spectrometry (ICP-MS). Concentrations for each cation were reported as micrograms per gram of total protein. Women with preeclampsia had significantly higher median leukocyte selenium concentrations than normotensive controls (3.23 vs 2.80 microg/g total protein, p < 0.0001). Median leukocyte zinc concentrations were 31% higher in preeclamptics as compared with controls (179.15 vs 136.44 microg/g total protein, p < 0.0001). Although median leukocyte copper concentrations were slightly higher for cases than controls, this difference did not reach statistical significance (17.72 vs 17.00 microg/g total protein, p = 0.468). There was evidence of a linear increase in risk of preeclampsia with increasing concentrations of selenium and zinc. The relative risk for preeclampsia was 3.38 (adjusted odds ratio [OR] = 3.38, 95% confidence interval [CI] = 1.53-7.54) among women in the highest quartile of the control selenium distribution compared with women in the lowest quartile. The corresponding relative risk and 95% CI for preeclampsia was 5.30 (2.45-11.44) for women in the highest quartile of the control zinc distribution compared with women in the lowest quartile. There was no clear pattern of a linear trend in risk with increasing concentration of leukocyte copper concentrations (adjusted for linear trend in risk = 0.299). Our results are consistent with some previous reports. Prospective studies are needed to determine whether observed alterations in selenium and zinc concentrations precede preeclampsia or whether the differences may be attributed to preeclampsia-related alterations in maternal and fetal-placental trace metal metabolism.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynecology, University of Zimbabwe, School of Medicine, Harare
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Abstract
BACKGROUND Folate depletion may result in anaemia during pregnancy. OBJECTIVES The objective of this review was to assess the effects of folate supplementation in pregnancy on haematological and biochemical parameters and measures of pregnancy outcome. This review did not address the role of periconceptual folate supplementation to diminish the risk of fetal malformation. SEARCH STRATEGY A comprehensive electronic search included that of the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA Acceptably controlled trials of folate supplementation compared with placebo or no treatment to pregnant women with normal haemoglobin levels. DATA COLLECTION AND ANALYSIS Trial quality was assessed. Study authors were contacted for additional information when necessary. MAIN RESULTS Twenty-one studies were included. The trials varied in quality. Compared to placebo or no supplementation, folate supplementation was associated with increased or maintained serum folate levels (odds ratio 0.18, 95% confidence interval 0.13 to 0.24) and red cell folate levels (odds ratio 0.18, 95% confidence interval 0.09 to 0.38). Folate supplementation was associated with a reduction in the proportion of women with low haemoglobin level in late pregnancy (odds ratio 0.61, 95% confidence interval 0.52 to 0.71) and megaloblastic erythropoiesis (odds ratio 0.65, 95% confidence interval 0.45 to 0.95). Apart from a possible reduction in the incidence of low birthweight, folate supplementation appears to have no measurable effect on any other substantive measures of pregnancy outcome. REVIEWER'S CONCLUSIONS Folate supplementation during pregnancy appears to improve haemoglobin levels and folate status. There is not enough evidence to evaluate whether folate supplementation has any effect, beneficial or harmful, on clinical outcomes for mother and baby.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
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Abstract
BACKGROUND Sickle cells have a shorter life span than normal red blood cells. It has been suggested that pregnancy complications for women with sickle cell anaemia may be reduced by regular blood transfusions. The aim is to maintain haemoglobin at 60-70% of the normal total. OBJECTIVES The objective of this review was to assess the effects of a policy of routine blood transfusion for pregnant women with sickle cell disease with a policy of selective transfusion. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA Acceptably controlled trials of blood transfusion in pregnant women with sickle cell disease. DATA COLLECTION AND ANALYSIS Eligibility, trial quality assessment and data extraction were done by one reviewer. MAIN RESULTS One trial involving 72 women was included. Half the women received blood transfusion only if haemoglobin fell below 6g% and the other half received two units of blood every week for three weeks, or until haemoglobin level was 10-11g%. A policy of selective transfusion reduced the number of transfusions required at the expense of more frequent pain crises. REVIEWER'S CONCLUSIONS There is not enough evidence to draw conclusions about the prophylactic use of blood transfusion for sickle cell anaemia during pregnancy.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.
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Rajkovic A, Mahomed K, Malinow MR, Sorenson TK, Woelk GB, Williams MA. Plasma homocyst(e)ine concentrations in eclamptic and preeclamptic African women postpartum. Obstet Gynecol 1999; 94:355-60. [PMID: 10472859 DOI: 10.1016/s0029-7844(99)00304-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the relationship between plasma homocyst(e)ine and risk of eclampsia and preeclampsia among sub-Saharan African women who delivered at Harare Maternity Hospital in Zimbabwe. METHODS We ran a hospital-based, case-control study at Harare Maternity Hospital, University of Zimbabwe, Harare, Zimbabwe comprising 33 pregnant women with eclampsia and 138 with preeclampsia. Controls were 185 normotensive pregnant women. Plasma was collected postpartum and homocyst(e)ine levels were measured by high-performance liquid chromatography and electrochemical detection. RESULTS Women with eclampsia or preeclampsia had significantly higher mean homocyst(e)ine levels than normotensive controls (12.54 or 12.77 micromol/L versus 9.93 micromol/L, respectively, P<.001). The odds ratio (OR) for eclampsia was 6.03 among women in the highest quartile of the control homocyst(e)ine distribution (median 13.9 micromol/L) compared with women in the lowest quartile (median 6.2 micromol/L). The corresponding OR for preeclampsia was 4.57. Nulliparas with elevated homocyst(e)ine had a 12.90 times higher risk of preeclampsia compared with multiparas without elevated homocyst(e)ine. CONCLUSION Postpartum plasma homocyst(e)ine concentrations are higher among Zimbabwean women with eclampsia and preeclampsia compared with normotensive women.
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Affiliation(s)
- A Rajkovic
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA.
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48
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Mahomed K. Hypertension in pregnancy--2--eclampsia. Cent Afr J Med 1999; 45:249-50. [PMID: 11019477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Eclampsia is a grand mal convulsion associated with pregnancy-induced hypertension. It is caused by cerebral hypoxia from intense vasospasm combined with cerebral oedema. CT scans show cerebral ischaemia from thrombosis and oedema.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe Medical School, Harare, Zimbabwe
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49
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Madzime S, Adem M, Mahomed K, Woelk GB, Mudzamiri S, Williams MA. Hepatitis B virus infection among pregnant women delivering at Harare Maternity Hospital, Harare Zimbabwe, 1996 to 1997. Cent Afr J Med 1999; 45:195-8. [PMID: 10697914 DOI: 10.4314/cajm.v45i8.8414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the prevalence of hepatitis B virus (HBV) carrier and infectivity status among pregnant women delivering at Harare Maternity Hospital. DESIGN A serological survey study of pregnant women admitted for labour and delivery. SETTING Harare Maternity Hospital, Harare, Zimbabwe between June 1996 and June 1997. SUBJECTS A random sample of 1,000 women, delivering at the hospital during the study period agreed to participate in the study. Serum samples were available for 984 women. MAIN OUTCOME MEASURES HBV carriage status was determined by the presence of hepatitis B surface antigen (HBsAg) by enzyme immunoassay (EIA). Maternal HBV infectivity status was determined by testing all HBsAg positive women for the presence of hepatitis e surface antigen (HBeAg) using EIA. RESULTS Overall 246 (25%) women were identified as carriers of HBV (95% confidence interval 22 to 28%). The frequency of HBV carriers did not vary with maternal age, parity or marital status. Only a positive prior history of spontaneous abortion was associated with an increased prevalence of HBV carriage status. Eight of the 246 (3.3%) women identified as HBV carriers tested positive for HBeAg. Hence, 0.8% of the entire study population was found to be at high risk of transmitting HBV to their newborns. CONCLUSIONS Our results demonstrate a high prevalence of HBV carriage among women giving birth at Harare Maternity Hospital. None of the demographic variables studied were important predictors of HBV carriage status. The high carriage rate and low infectivity rates suggest that HBV infection is likely to be acquired by horizontal, rather than by vertical means of transmission. Given the scarcity of financial resources, routine testing of mothers for HBsAg may not be feasible. Our results suggest, however, that mass vaccination of all infants, irrespective of maternal HBV carriage status, may be the most effective approach to HBV prevention and control in Zimbabwe.
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Affiliation(s)
- S Madzime
- Department of Obstetrics and Gynaecology, University of Zimbabwe Medical School, Avondale, Harare, Zimbabwe
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50
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Mahomed K. Hypertension in pregnancy--1. Cent Afr J Med 1999; 45:224-7. [PMID: 10697921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This review is aimed at clinicians working in a country like Zimbabwe, with limited health care resources. The management of the condition includes early detection, control of blood pressure, monitoring for maternal and foetal complications with timely delivery by the most appropriate route.
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Affiliation(s)
- K Mahomed
- Department of Obstetrics and Gynaecology, University of Zimbabwe Medical School, Avondale, Harare, Zimbabwe
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