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Kemp JF, Hambidge KM, Westcott JL, Ali SA, Saleem S, Garcés A, Figueroa L, Somannavar MS, Goudar SS, Long JM, Hendricks AE, Krebs NF. Zinc Supplementation Initiated Prior to or During Pregnancy Modestly Impacted Maternal Status and High Prevalence of Hypozincemia in Pregnancy and Lactation: The Women First Preconception Maternal Nutrition Trial. J Nutr 2024:S0022-3166(24)00221-9. [PMID: 38621624 DOI: 10.1016/j.tjnut.2024.04.018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Data regarding effects of small-quantity-lipid-based nutrient supplements (SQ-LNS) on maternal serum zinc concentrations (SZC) in pregnancy and lactation are limited. OBJECTIVES The objectives of this study were to evaluate the effect of preconception compared with prenatal zinc supplementation (compared with control) on maternal SZC and hypozincemia during pregnancy and early lactation in women in low-resource settings, and assess associations with birth anthropometry. METHODS From ∼100 women/arm at each of 3 sites (Guatemala, India, and Pakistan) of the Women First Preconception Maternal Nutrition trial, we compared SZC at 12- and 34-wk gestation (n = 651 and 838, respectively) and 3-mo postpartum (n = 742) in women randomly assigned to daily SQ-LNS containing 15 mg zinc from ≥3 mo before conception (preconception, arm 1), from ∼12 wk gestation through delivery (early pregnancy, arm 2) or not at all (control, arm 3). Birth anthropometry was examined for newborns with ultrasound-determined gestational age. Statistical analyses were performed separately for each time point. RESULTS At 12-wk gestation and 3-mo postpartum, no statistical differences in mean SZC were observed among arms. At 34-wk, mean SZC for arms 1 and 2 were significantly higher than for arm 3 (50.3, 50.8, 47.8 μg/dL, respectively; P = 0.005). Results were not impacted by correction for inflammation or albumin concentrations. Prevalence of hypozincemia at 12-wk (<56 μg/dL) was 23% in Guatemala, 26% in India, and 65% in Pakistan; at 34 wk (<50 μg/dL), 36% in Guatemala, 48% in India, and 74% in Pakistan; and at 3-mo postpartum (<66 μg/dL) 79% in Guatemala, 91% in India, and 92% in Pakistan. Maternal hypozincemia at 34-wk was associated with lower birth length-for-age Z-scores (all sites P = 0.013, Pakistan P = 0.008) and weight-for-age Z-scores (all sites P = 0.017, Pakistan P = 0.022). CONCLUSIONS Despite daily zinc supplementation for ≥7 mo, high rates of maternal hypozincemia were observed. The association of hypozincemia with impaired fetal growth suggests widespread zinc deficiency in these settings. This trial is registered at clinicaltrials.gov as #NCT01883193.
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Affiliation(s)
- Jennifer F Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jamie L Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sumera Aziz Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Ana Garcés
- Maternal Infant Health Center, Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Lester Figueroa
- Maternal Infant Health Center, Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - Manjunath S Somannavar
- Women's and Children's Health Research Unit, KLE Academy of Higher Education & Research's JN Medical College, Belagavi, Karnataka, India
| | - Shivaprasad S Goudar
- Women's and Children's Health Research Unit, KLE Academy of Higher Education & Research's JN Medical College, Belagavi, Karnataka, India
| | - Julie M Long
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Audrey E Hendricks
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO, United States; Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, United States
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States.
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Chiwila MK, Krebs NF, Manasyan A, Chomba E, Mwenechanya M, Mazariegos M, Sami N, Pasha O, Tshefu A, Lokangaka A, Goldenberg RL, Bose CL, Koso-Thomas M, Goco N, Do BT, McClure EM, Hambidge KM, Westcott JE, Carlo WA. Junk food use and neurodevelopmental and growth outcomes in infants in low-resource settings. Front Public Health 2024; 12:1308685. [PMID: 38686037 PMCID: PMC11057493 DOI: 10.3389/fpubh.2024.1308685] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Feeding infants a sub-optimal diet deprives them of critical nutrients for their physical and cognitive development. The objective of this study is to describe the intake of foods of low nutritional value (junk foods) and identify the association with growth and developmental outcomes in infants up to 18 months in low-resource settings. Methods This is a secondary analysis of data from an iron-rich complementary foods (meat versus fortified cereal) randomized clinical trial on nutrition conducted in low-resource settings in four low- and middle-income countries (Democratic Republic of the Congo, Guatemala, Pakistan, and Zambia). Mothers in both study arms received nutritional messages on the importance of exclusive breastfeeding up to 6 months with continued breastfeeding up to at least 12 months. This study was designed to identify the socio-demographic predictors of feeding infants' complementary foods of low nutritional value (junk foods) and to assess the associations between prevalence of junk food use with neurodevelopment (assessed with the Bayley Scales of Infant Development II) and growth at 18 months. Results 1,231 infants were enrolled, and 1,062 (86%) completed the study. Junk food feeding was more common in Guatemala, Pakistan, and Zambia than in the Democratic Republic of Congo. 7% of the infants were fed junk foods at 6 months which increased to 70% at 12 months. Non-exclusive breastfeeding at 6 months, higher maternal body mass index, more years of maternal and paternal education, and higher socioeconomic status were associated with feeding junk food. Prevalence of junk foods use was not associated with adverse neurodevelopmental or growth outcomes. Conclusion The frequency of consumption of junk food was high in these low-resource settings but was not associated with adverse neurodevelopment or growth over the study period.
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Affiliation(s)
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Albert Manasyan
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Elwyn Chomba
- Global Network, University Teaching Hospital, Lusaka, Zambia
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Manolo Mazariegos
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | - Neelofar Sami
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Antoinette Tshefu
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Adrien Lokangaka
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, United States
| | - Carl L. Bose
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shiver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Norman Goco
- Research Triangle Institute International, Durham, NC, United States
| | - Barbara T. Do
- Research Triangle Institute International, Durham, NC, United States
| | | | | | - Jamie E. Westcott
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
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Hoffman MK, Goudar S, Dhaded S, Figueroa L, Mazariegos M, Krebs NF, Westcott J, Tikmani SS, Karim F, Saleem S, Goldenberg RL, Lokangaka A, Tshefu A, Bauserman M, Patel A, Das P, Hibberd P, Chomba E, Mwenchanya M, Carlo WA, Trotta M, Williams A, Moore J, Nolen T, Goco N, McClure EM, Lobo MA, Cunha AB, Derman RJ. Neurodevelopment of Children Whose Mothers Were Randomized to Low-Dose Aspirin During Pregnancy. Obstet Gynecol 2024; 143:554-561. [PMID: 38262066 PMCID: PMC10953679 DOI: 10.1097/aog.0000000000005514] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Because low-dose aspirin is now commonly prescribed in pregnancy, we sought to assess the association between early antenatal exposure and child neurodevelopment. METHODS We performed a noninferiority, masked, neurodevelopmental follow-up study of children between age 33 and 39 months whose mothers had been randomized to daily low-dose aspirin (81 mg) or placebo between 6 0/7 and 13 6/7 weeks of gestation through 37 weeks. Neurodevelopment was assessed with the Bayley-III (Bayley Scales of Infant and Toddler Development, 3rd Edition) and the ASQ-3 (Ages and Stages Questionnaire, 3rd Edition). The primary outcome was the Bayley-III cognitive composite score with a difference within 4 points demonstrating noninferiority. RESULTS A total of 640 children (329 in the low-dose aspirin group, 311 in the placebo group) were evaluated between September 2021 and June 2022. The Bayley-III cognitive composite score was noninferior between the two groups (-1, adjusted mean -0.8, 95% CI, -2.2 to 0.60). Significant differences were not seen in the language composite score (difference 0.7, 95% CI, -0.8 to 2.1) or the motor composite score (difference -0.6, 95% CI, -2.5 to 1.2). The proportion of children who had any component of the Bayley-III score lower than 70 did not differ between the two groups. Similarly, the communication, gross motor, fine motor, problem-solving, and personal-social components of the ASQ-3 did not differ between groups. Maternal characteristics, delivery outcomes, breastfeeding rates, breastfeeding duration, and home environment as measured by the Family Care Indicators were similar. CONCLUSION Antenatal low-dose aspirin exposure was not associated with altered neurodevelopmental outcomes at age 3 years. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT04888377.
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Affiliation(s)
- Matthew K Hoffman
- Christiana Care and the University of Delaware, Newark, Delaware; Jawaharlal Nehru Medical College, KLE University, Belgavi, Lata Medical Research Foundation, Nagpur, and Datta Meghe Institute of Higher Education and Research, Wardha, India; Instituto de Nutrición de Centro América y Panamá, Guatemala; University of Colorado Anschutz Medical Campus, Aurora, Colorado; Aga Khan University, Karachi, Pakistan; Columbia University, New York, New York; Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo; University of North Carolina at Chapel Hill, Chapel Hill, and RTI International, Research Triangle, North Carolina; Boston University School of Public Health, Boston, Massachusetts; University Teaching Hospital, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, Alabama; University of Nebraska Medical Center, Omaha, Nebraska; and Thomas Jefferson University, Philadelphia, Pennsylvania
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Nuss EE, Hoffman MK, Goudar SS, Kavi A, Metgud M, Somannavar M, Okitawutshu J, Lokangaka A, Tshefu A, Bauserman M, Tembo AM, Chomba E, Carlo WA, Figueroa L, Krebs NF, Jessani S, Saleem S, Goldenberg RL, Kurhe K, Das P, Hibberd PL, Achieng E, Nyongesa P, Esamai F, Liechty EA, Bucher S, Goco N, Hemingway-Foday J, Moore J, McClure EM, Silver RM, Derman RJ, Patel A. Corrigendum to The impact of risk factors on aspirin's efficacy for the prevention of preterm birth. American Journal of Obstetrics & Gynecology MFM. Volume 5, Issue 10, October 2023, 101095. Am J Obstet Gynecol MFM 2024:101309. [PMID: 38395633 DOI: 10.1016/j.ajogmf.2024.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- Emily E Nuss
- Christiana Care, Newark, DE (Drs Nuss and Hoffman).
| | | | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, India (Drs Goudar, Kavi, Metgud, and Somannavar)
| | - Avinash Kavi
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, India (Drs Goudar, Kavi, Metgud, and Somannavar)
| | - Mrityunjay Metgud
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, India (Drs Goudar, Kavi, Metgud, and Somannavar)
| | - Manjunath Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, India (Drs Goudar, Kavi, Metgud, and Somannavar)
| | - Jean Okitawutshu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (Drs Okitawutshu, Lokangaka, and Tshefu)
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (Drs Okitawutshu, Lokangaka, and Tshefu)
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (Drs Okitawutshu, Lokangaka, and Tshefu)
| | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, NC (Dr Bauserman)
| | | | - Elwyn Chomba
- University Teaching Hospital, Lusaka, Zambia (Ms Tembo and Dr Chomba)
| | | | - Lester Figueroa
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala (Dr Figueroa)
| | - Nancy F Krebs
- University of Colorado Denver, Denver, CO (Dr Krebs)
| | - Saleem Jessani
- Aga Khan University, Karachi, Pakistan (Drs Jessani and Saleem)
| | - Sarah Saleem
- Aga Khan University, Karachi, Pakistan (Drs Jessani and Saleem)
| | | | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India (Drs Kurhe, Das, and Patel)
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, India (Drs Kurhe, Das, and Patel)
| | | | - Emmah Achieng
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya (Ms Achieng and Drs Nyongesa and Esamai)
| | - Paul Nyongesa
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya (Ms Achieng and Drs Nyongesa and Esamai)
| | - Fabian Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya (Ms Achieng and Drs Nyongesa and Esamai)
| | - Edward A Liechty
- School of Medicine, Indiana University, Indianapolis, IN (Drs Liechty and Bucher)
| | - Sherri Bucher
- School of Medicine, Indiana University, Indianapolis, IN (Drs Liechty and Bucher)
| | - Norman Goco
- RTI International, Research Triangle Park, NC (Mr Goco, Mses Hemingway-Foday and Moore, and Dr McClure)
| | - Jennifer Hemingway-Foday
- RTI International, Research Triangle Park, NC (Mr Goco, Mses Hemingway-Foday and Moore, and Dr McClure)
| | - Janet Moore
- RTI International, Research Triangle Park, NC (Mr Goco, Mses Hemingway-Foday and Moore, and Dr McClure)
| | - Elizabeth M McClure
- RTI International, Research Triangle Park, NC (Mr Goco, Mses Hemingway-Foday and Moore, and Dr McClure)
| | | | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India (Drs Kurhe, Das, and Patel); Datta Meghe Institute of Higher Education and Research, Wardha, India (Dr. Patel)
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Hill EB, Tang M, Long JM, Kemp JF, Westcott JL, Hendricks AE, Reisdorph NA, Campbell WW, Krebs NF. mini-MED: study protocol for a randomized, multi-intervention, semi-controlled feeding trial of a Mediterranean-amplified vs. habitual Western dietary pattern for the evaluation of food-specific compounds and cardiometabolic health. Trials 2024; 25:101. [PMID: 38302990 PMCID: PMC10835998 DOI: 10.1186/s13063-024-07939-8] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Diet is among the most influential lifestyle factors impacting chronic disease risk. Nutrimetabolomics, the application of metabolomics to nutrition research, allows for the detection of food-specific compounds (FSCs) that can be used to connect dietary patterns, such as a Mediterranean-style (MED) diet, to health. This validation study is based upon analyses from a controlled feeding MED intervention, where our team identified FSCs from eight foods that can be detected in biospecimens after consumption and may therefore serve as food intake biomarkers. METHODS Individuals with overweight/obesity who do not habitually consume a MED dietary pattern will complete a 16-week randomized, multi-intervention, semi-controlled feeding study of isocaloric dietary interventions: (1) MED-amplified dietary pattern, containing 500 kcal/day from eight MED target foods: avocado, basil, cherry, chickpea, oat, red bell pepper, walnut, and a protein source (alternating between salmon or unprocessed, lean beef), and (2) habitual/Western dietary pattern, containing 500 kcal/day from six non-MED target foods: cheesecake, chocolate frozen yogurt, refined grain bread, sour cream, white potato, and unprocessed, lean beef. After a 2-week washout, participants complete four, 4-week intervention periods, with biospecimen sampling and outcome assessments at baseline and at intervention weeks 4, 8, 12, and 16. The primary outcome is change in the relative abundance of FSCs from the eight MED target foods in participant biospecimens from baseline to the end of each intervention period. Secondary outcomes include mean change in cardiometabolic health indicators, inflammatory markers, and adipokines. Exploratory outcomes include change in diversity and community composition of the gut microbiota. DISCUSSION Our stepwise strategy, beginning with identification of FSCs in whole diets and biospecimens, followed by relating these to health indicators will lead to improved methodology for assessment of dietary patterns and a better understanding of the relationship between food and health. This study will serve as a first step toward validating candidate food intake biomarkers and allow for assessment of relationships with cardiometabolic health. The identification of food intake biomarkers is critical to future research and has implications spanning health promotion and disease prevention for many chronic conditions. TRIAL REGISTRATION Registered at ClinicalTrials.gov: NCT05500976 ; Date of registration: August 15, 2022.
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Affiliation(s)
- Emily B Hill
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Minghua Tang
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Julie M Long
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Jennifer F Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Jamie L Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Audrey E Hendricks
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, 80204, USA
| | - Nichole A Reisdorph
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN, 47906, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
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Best CM, Krebs NF, Duggan CP. A new series: Nutrition for the Clinician. Am J Clin Nutr 2024; 119:237-238. [PMID: 38309819 DOI: 10.1016/j.ajcnut.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 02/05/2024] Open
Affiliation(s)
- Cora M Best
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, United States
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Christopher P Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, United States
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Waldrop SW, Krebs NF. A perfect storm in a pandemic-a child with complex medical history and special diet encounters COVID. Am J Clin Nutr 2024; 119:255-261. [PMID: 38233266 PMCID: PMC10884600 DOI: 10.1016/j.ajcnut.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 01/19/2024] Open
Affiliation(s)
- Stephanie W Waldrop
- Section of Nutrition, Department of Pediatrics, University of Colorado, Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, CO, United States
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado, Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, CO, United States.
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Uffelman CN, Schmok JN, Campbell RE, Hartman AS, Olson MR, Anderson NL, Reisdorph NA, Tang M, Krebs NF, Campbell WW. Consuming Mushrooms When Adopting a Healthy Mediterranean-Style Dietary Pattern Does Not Influence Short-Term Changes of Most Cardiometabolic Disease Risk Factors in Healthy Middle-Aged and Older Adults. J Nutr 2024; 154:574-582. [PMID: 38135005 PMCID: PMC10997904 DOI: 10.1016/j.tjnut.2023.12.026] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Mushrooms are a nutritious food, though knowledge of the effects of mushroom consumption on cardiometabolic risk factors is limited and inconsistent. OBJECTIVE We assessed the effects of consuming mushrooms as part of a healthy United States Mediterranean-style dietary pattern (MED) on traditional and emerging cardiometabolic disease (CMD) risk factors. We hypothesized that adopting a MED diet with mushrooms would lead to greater improvements in multiple CMD risk factors. METHODS Using a randomized, parallel study design, 60 adults (36 females, 24 males; aged 46 ± 12 y; body mass index 28.3 ± 2.84 kg/m2, mean ± standard deviation) without diagnosed CMD morbidities consumed a MED diet (all foods provided) without (control with breadcrumbs) or with 84 g/d of Agaricus bisporus (White Button, 4 d/wk) and Pleurotus ostreatus (Oyster, 3 d/wk) mushrooms for 8 wk. Fasting baseline and postintervention outcome measurements were traditional CMD risk factors, including blood pressure and fasting serum lipids, lipoproteins, glucose, and insulin. Exploratory CMD-related outcomes included lipoprotein particle sizes and indexes of inflammation. RESULTS Adopting the MED-mushroom diet compared with the MED-control diet without mushrooms improved fasting serum glucose (change from baseline -2.9 ± 1.18 compared with 0.6 ± 1.10 mg/dL; time × group P = 0.034). Adopting the MED diet, independent of mushroom consumption, reduced serum total cholesterol (-10.2 ± 3.77 mg/dL; time P = 0.0001). Concomitantly, there was a reduction in high-density lipoprotein (HDL) cholesterol, buoyant HDL2b, and apolipoprotein A1, and an increase in lipoprotein(a) concentrations (main effect of time P < 0.05 for all). There were no changes in other measured CMD risk factors. CONCLUSIONS Consuming a Mediterranean-style healthy dietary pattern with 1 serving/d of whole Agaricus bisporus and Pleurotus ostreatus mushrooms improved fasting serum glucose but did not influence other established or emerging CMD risk factors among middle-aged and older adults classified as overweight or obese but with clinically normal cardiometabolic health. TRIAL REGISTRATION NUMBER https://www. CLINICALTRIALS gov/study/NCT04259229?term=NCT04259229&rank=1.
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Affiliation(s)
- Cassi N Uffelman
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, United States
| | - Jacqueline N Schmok
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, United States
| | - Robyn E Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, United States
| | - Austin S Hartman
- Department of Statistics, Purdue University, West Lafayette, Indiana , United States
| | - Matthew R Olson
- Department of Biological Science, Purdue University, West Lafayette, Indiana , United States
| | - Nicole L Anderson
- Department of Biological Science, Purdue University, West Lafayette, Indiana , United States
| | - Nichole A Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Minghua Tang
- School of Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Nancy F Krebs
- School of Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, United States.
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Hill EB, Reisdorph RM, Rasolofomanana-Rajery S, Michel C, Khajeh-Sharafabadi M, Doenges KA, Weaver N, Quinn K, Sutliff AK, Tang M, Borengasser SJ, Frank DN, O'Connor LE, Campbell WW, Krebs NF, Hendricks AE, Reisdorph NA. Salmon Food-Specific Compounds and Their Metabolites Increase in Human Plasma and Are Associated with Cardiometabolic Health Indicators Following a Mediterranean-Style Diet Intervention. J Nutr 2024; 154:26-40. [PMID: 37918675 PMCID: PMC10808825 DOI: 10.1016/j.tjnut.2023.10.024] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/25/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Nutrimetabolomics allows for the comprehensive analysis of foods and human biospecimens to identify biomarkers of intake and begin to probe their associations with health. Salmon contains hundreds of compounds that may provide cardiometabolic benefits. OBJECTIVES We used untargeted metabolomics to identify salmon food-specific compounds (FSCs) and their predicted metabolites that were found in plasma after a salmon-containing Mediterranean-style (MED) diet intervention. Associations between changes in salmon FSCs and changes in cardiometabolic health indicators (CHIs) were also explored. METHODS For this secondary analysis of a randomized, crossover, controlled feeding trial, 41 participants consumed MED diets with 2 servings of salmon per week for 2 5-wk periods. CHIs were assessed, and fasting plasma was collected pre- and postintervention. Plasma, salmon, and 99 MED foods were analyzed using liquid chromatography-mass spectrometry-based metabolomics. Compounds were characterized as salmon FSCs if detected in all salmon replicates but none of the other foods. Metabolites of salmon FSCs were predicted using machine learning. For salmon FSCs and metabolites found in plasma, linear mixed-effect models were used to assess change from pre- to postintervention and associations with changes in CHIs. RESULTS Relative to the other 99 MED foods, there were 508 salmon FSCs with 237 unique metabolites. A total of 143 salmon FSCs and 106 metabolites were detected in plasma. Forty-eight salmon FSCs and 30 metabolites increased after the intervention (false discovery rate <0.05). Increases in 2 annotated salmon FSCs and 2 metabolites were associated with improvements in CHIs, including total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B. CONCLUSIONS A data-driven nutrimetabolomics strategy identified salmon FSCs and their predicted metabolites that were detectable in plasma and changed after consumption of a salmon-containing MED diet. Findings support this approach for the discovery of compounds in foods that may serve, upon further validation, as biomarkers or act as bioactive components influential to health. The trials supporting this work were registered at NCT02573129 (Mediterranean-style diet intervention) and NCT05500976 (ongoing clinical trial).
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Affiliation(s)
- Emily B Hill
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Richard M Reisdorph
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sakaiza Rasolofomanana-Rajery
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, United States; Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Cole Michel
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Mobin Khajeh-Sharafabadi
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, United States
| | - Katrina A Doenges
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nicholas Weaver
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, United States
| | - Kevin Quinn
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Aimee K Sutliff
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Minghua Tang
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sarah J Borengasser
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel N Frank
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lauren E O'Connor
- USDA, Agricultural Research Service, Beltsville Human Nutrition Research Center, Food Components and Health Laboratory, Beltsville, MD, United States
| | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Audrey E Hendricks
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, United States; Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Nichole A Reisdorph
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
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10
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Long JM, Gatica‐Domínguez G, Westcott JE, Taren D, Tejeda G, Diba TS, Mastiholi SC, Khan US, Garcés A, Figueroa L, Lokangaka A, Goudar SS, Aziz Ali S, Hambidge KM, Krebs NF. Infant and young child feeding indicators are positively associated with length and family care indicators in the children of the Women First trial participants. Matern Child Nutr 2024; 20:e13572. [PMID: 37817452 PMCID: PMC10750017 DOI: 10.1111/mcn.13572] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 10/12/2023]
Abstract
This research describes the proportion of children in four low- and middle-income countries with adequate dietary practices at 6, 12, 18 and 24 months of age and how these practices changed over time using the World Health Organisation and UNICEF's infant young child feeding (IYCF) indicators. The associations between the IYCF indicators and anthropometric z-scores from 6 to 24 months, and between the IYCF indicators and the family care indicators (FCIs) at 24 months are described. This was a longitudinal study of offspring from participants in the Women First Preconception Maternal Nutrition Trial conducted in Sud-Ubangi, Democratic Republic of Congo; Chimaltenango, Guatemala; Belagavi, North Karnataka, India; and Thatta, Sindh Province, Pakistan. The frequency of the minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum adequate diet (MAD) increased between 6 and 24 months, but even at 24 months MAD remained below 50% at all sites. MDD (β = 0.12; 95% CI = 0.04-0.22) and MMF (β = 0.10; 95% CI = 0.03-0.17) were positively associated with length-for-age z-score at 24 months. All IYCF indicators were positively associated with mean total FCI score: MDD (proportion ratio [PR] = 1.04; 95% CI = 1.02-1.07), MMF (PR = 1.02; 95% CI = 1.01-1.04), MAD (PR = 1.05; 95% CI = 1.02-1.08). Although there are multiple barriers to young children having an adequate diet, our results support a positive association between familial interactions and improved IYCF feeding practices.
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Affiliation(s)
- Julie M. Long
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Giovanna Gatica‐Domínguez
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Jamie E. Westcott
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Douglas Taren
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Gabriela Tejeda
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Tshilenge S. Diba
- Kinshasa School of Public Health, Democratic Republic of CongoKinshasaDemocratic Republic of the Congo
| | - Shivanand C. Mastiholi
- Women's and Children's Health Research UnitKLE Academy of Higher Education and Research's Jawaharlal Nehru Medical CollegeBelagaviIndia
| | - Umber S. Khan
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - Ana Garcés
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Lester Figueroa
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Democratic Republic of CongoKinshasaDemocratic Republic of the Congo
| | - Shivaprasad S. Goudar
- Women's and Children's Health Research UnitKLE Academy of Higher Education and Research's Jawaharlal Nehru Medical CollegeBelagaviIndia
| | - Sumera Aziz Ali
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - K. Michael Hambidge
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Nancy F. Krebs
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
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11
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Switchenko N, Shukla V, Mwenechanya M, Chomba E, Patel A, Hibberd PL, Ambalavanan N, Figueroa L, Mazariegos M, Krebs NF, Goudar SS, Derman R, Esamai F, Liechty EA, Bucher S, Saleem S, Goldenberg RL, Lokangaka A, Tshefu A, Bose CL, Koso-Thomas M, Tan S, Nolen T, McClure EM, Carlo WA. Neonatal Respiratory Support Utilization in Low- and Middle-Income Countries: A Registry-Based Observational Study. Neonatology 2023; 121:116-124. [PMID: 38048757 DOI: 10.1159/000534777] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/11/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Newborns with hypoxemia often require life-saving respiratory support. In low-resource settings, it is unknown if respiratory support is delivered more frequently to term infants or preterm infants. We hypothesized that in a registry-based birth cohort in 105 geographic areas in seven low- and middle-income countries, more term newborns received respiratory support than preterm newborns. METHODS This is a hypothesis-driven observational study based on prospectively collected data from the Maternal and Newborn Health Registry of the NICHD Global Network for Women's and Children's Health Research. Eligible infants enrolled in the registry were live-born between 22 and 44 weeks gestation with a birth weight ≥400 g and born from January 1, 2015, to December 31, 2018. Frequency data were obtained to report the number of term and preterm infants who received treatment with oxygen only, CPAP, or mechanical ventilation. Test for trends over time were conducted using robust Poisson regression. RESULTS 177,728 (86.3%) infants included in this study were term, and 28,249 (13.7%) were preterm. A larger number of term infants (n = 5,108) received respiratory support compared to preterm infants (n = 3,287). Receipt of each mode of respiratory support was more frequent in term infants. The proportion of preterm infants who received respiratory support (11.6%) was higher than the proportion of term infants receiving respiratory support (2.9%, p < 0.001). The rate of provision of respiratory support varied between sites. CONCLUSIONS Respiratory support was more frequently used in term infants expected to be at low risk for respiratory disorders compared to preterm infants.
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Affiliation(s)
- Nora Switchenko
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vivek Shukla
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Archana Patel
- Lata Medical Research Foundation, India and Datta Meghe Institute of Medical Sciences, Nagpur, India
| | | | | | | | | | - Nancy F Krebs
- Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J. N. Medical College, Belagavi, India
| | - Richard Derman
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fabian Esamai
- Department of Pediatrics, Moi University, Eldoret, Kenya
| | - Edward A Liechty
- Department of Pediatrics, Indiana University, Bloomington, Indiana, USA
| | - Sheri Bucher
- Department of Pediatrics, Indiana University, Bloomington, Indiana, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L Goldenberg
- Department of Obstetrics/Gynecology, Columbia University, New York, New York, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Carl L Bose
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Sylvia Tan
- RTI International, Durham, North Carolina, USA
| | - Tracy Nolen
- RTI International, Durham, North Carolina, USA
| | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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12
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Nyongesa P, Ekhaguere OA, Marete I, Tenge C, Kemoi M, Bann CM, Bucher SL, Patel AB, Hibberd PL, Naqvi F, Saleem S, Goldenberg RL, Goudar SS, Derman RJ, Krebs NF, Garces A, Chomba E, Carlo WA, Mwenechanya M, Lokangaka A, Tshefu AK, Bauserman M, Koso-Thomas M, Moore JL, McClure EM, Liechty EA, Esamai F. Maternal age extremes and adverse pregnancy outcomes in low-resourced settings. Front Glob Womens Health 2023; 4:1201037. [PMID: 38090046 PMCID: PMC10715413 DOI: 10.3389/fgwh.2023.1201037] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/14/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low- and middle-income countries where the burden of adverse pregnancy outcomes is highest. Objective To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries. Patients and methods We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia between 2010 and 2020. We included pregnant women and their neonates. We describe the prevalence and adverse pregnancy outcomes associated with pregnancies in these maternal age groups (<20, 20-24, 25-29, 30-35, and >35 years). Relative risks and 95% confidence intervals of each adverse pregnancy outcome comparing each maternal age group to the reference group of 20-24 years were obtained by fitting a Poisson model adjusting for site, maternal age, parity, multiple gestations, maternal education, antenatal care, and delivery location. Analysis by region was also performed. Results We analyzed 602,884 deliveries; 13% (78,584) were adolescents, and 5% (28,677) were advanced maternal age (AMA). The overall maternal mortality ratio (MMR) was 147 deaths per 100,000 live births and increased with advancing maternal age: 83 in the adolescent and 298 in the AMA group. The AMA groups had the highest MMR in all regions. Adolescent pregnancy was associated with an adjusted relative risk (aRR) of 1.07 (1.02-1.11) for perinatal mortality and 1.13 (1.06-1.19) for neonatal mortality. In contrast, AMA was associated with an aRR of 2.55 (1.81 to 3.59) for maternal mortality, 1.58 (1.49-1.67) for perinatal mortality, and 1.30 (1.20-1.41) for neonatal mortality, compared to pregnancy in women 20-24 years. This pattern was overall similar in all regions, even in the <18 and 18-19 age groups. Conclusion The maternal mortality ratio in the LMICs assessed is high and increased with advancing maternal age groups. While less prevalent, AMA was associated with a higher risk of adverse maternal mortality and, like adolescence, was associated with adverse perinatal mortality with little regional variation.
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Affiliation(s)
- Paul Nyongesa
- Department of Obstetrics and Gynecology, Moi University School of Medicine, Eldoret, Kenya
| | - Osayame A. Ekhaguere
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Irene Marete
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Constance Tenge
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Milsort Kemoi
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Carla M. Bann
- Social Statistical, and Environmental Sciences Unit, RTI International, Durham, NC, United States
| | - Sherri L. Bucher
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, IU-Indianapolis, Indianapolis, IN, United States
| | - Archana B. Patel
- Department of Pediatrics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Farnaz Naqvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, United States
| | - Shivaprasad S. Goudar
- Women's and Children's Health Research Unit, J N Medical College Belagavi, KLE Academy Higher Education and Research, Karnataka, India
| | - Richard J. Derman
- Global Affairs, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nancy F. Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Ana Garces
- Department of Pediatrics, Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Adrien Lokangaka
- Department of Pediatrics, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Antoinette K. Tshefu
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Melissa Bauserman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MA, United States
| | - Janet L. Moore
- Social Statistical, and Environmental Sciences Unit, RTI International, Durham, NC, United States
| | - Elizabeth M. McClure
- Social Statistical, and Environmental Sciences Unit, RTI International, Durham, NC, United States
| | - Edward A. Liechty
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Fabian Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
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13
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Shankar K, Hwang K, Westcott JL, Saleem S, Aziz SA, Jessani S, Patel A, Kavi A, Somannavar MS, Goudar SS, Hibberd PL, Derman RJ, Hoffman M, Wylie BJ, Goldenberg RL, Thorsten VR, McClure EM, Krebs NF. Associations between ambient temperature and pregnancy outcomes from three south Asian sites of the Global Network Maternal Newborn Health Registry: A retrospective cohort study. BJOG 2023; 130 Suppl 3:124-133. [PMID: 37581948 PMCID: PMC10843605 DOI: 10.1111/1471-0528.17616] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/30/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Growing evidence suggests that environmental heat stress negatively influences fetal growth and pregnancy outcomes. However, few studies have examined the impact of heat stress on pregnancy outcomes in low-resource settings. We combined data from a large multi-country maternal-child health registry and meteorological data to assess the impacts of heat stress. DESIGN Retrospective cohort study. SETTING Three sites based in south Asia as part of the Global Network for Women's and Children's Health research in India (Belagavi and Nagpur) and Pakistan (Thatta). POPULATION OR SAMPLE Data from women enrolled between 2014 and 2020 in the Global Network's Maternal Newborn Health Registry (MNHR), a prospective, population-based registry of pregnancies, were used. METHODS A total of 126 273 pregnant women were included in this analysis. Daily maximal air temperatures (Tmax ) were acquired from local meteorological records. Associations between averages of daily maximal temperatures for each trimester and main outcomes were analysed using a modified Poisson regression approach. MAIN OUTCOMES MEASURES Incidence of stillbirth, preterm birth, low birthweight (<2500 g) or evidence of pregnancy hypertension or pre-eclampsia. RESULTS In the overall cohort, risk of preterm birth was positively associated with greater temperature in the second trimester (relative risk [RR] 1.05, 95% CI 1.02-1.07, p = 0.0002). Among individual sites, the risk of preterm birth was greatest in Nagpur (RR 1.07, 95% CI 1.03-1.11, p = 0.0005) and associated with second-trimester temperature. The overall risk of low birthweight was associated with ambient temperature in second trimester (RR 1.02, 95% CI 1.01-1.04, p = 0.01). The risk for LBW was associated with first-trimester heat in Thatta and with second-trimester heat in Nagpur. Finally, the overall risk of gestational hypertensive disease was associated with greater temperature in the third trimester among all sites (RR 1.07, 95% CI 1.02-1.12, p = 0.005) and was particularly significant for Nagpur (RR 1.13, 95% CI 1.05-1.23, p = 0.002). These findings highlight the increased risk of detrimental obstetric and neonatal outcomes with greater temperature. CONCLUSION In a multi-country, community-based study, greater risk of adverse outcomes was observed with increasing temperature. The study highlights the need for deeper understanding of covarying factors and intervention strategies, especially in regions where high temperatures are common.
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Affiliation(s)
- Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | - Jamie L. Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | - Shivaprasad S. Goudar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | | | - Matthew Hoffman
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Christiana Care Health System, Delaware, USA
| | - Blair J. Wylie
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | | | | | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado, USA
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14
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Goldenberg RL, Goudar SS, Kavi A, Krebs NF, Derman RJ, Saleem S, McClure EM. Improving maternal, neonatal and child health outcomes in low-resource settings: Translating research evidence to practice - report from The Third International Conference on Maternal, Newborn and Child Health. BJOG 2023; 130 Suppl 3:4-7. [PMID: 37530445 DOI: 10.1111/1471-0528.17609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Affiliation(s)
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Avinash Kavi
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
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15
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Figueroa L, Harrison M, Mazariegos M, Goudar S, Kavi A, Derman R, Patel A, Das P, Hibberd PL, Saleem S, Naqvi F, Goldenberg RL, Haque R, Billah SM, Petri WA, McClure EM, Tan S, Krebs NF. Maternal and perinatal outcomes of women with vaginal birth after cesarean section compared to repeat cesarean birth in select South Asian and Latin American settings of the global network for women's and children's health research. Matern Health Neonatol Perinatol 2023; 9:13. [PMID: 37908009 PMCID: PMC10619270 DOI: 10.1186/s40748-023-00169-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Our objective was to analyze a prospective population-based registry including five sites in four low- and middle-income countries to observe characteristics associated with vaginal birth after cesarean versus repeat cesarean birth, as well as maternal and newborn outcomes associated with the mode of birth among women with a history of prior cesarean. HYPOTHESIS Maternal and perinatal outcomes among vaginal birth after cesarean section will be similar to those among recurrent cesarean birth. METHODS A prospective population-based study, including home and facility births among women enrolled from 2017 to 2020, was performed in communities in Guatemala, India (Belagavi and Nagpur), Pakistan, and Bangladesh. Women were enrolled during pregnancy, and delivery outcome data were collected within 42 days after birth. RESULTS We analyzed 8267 women with a history of prior cesarean birth; 1389 (16.8%) experienced vaginal birth after cesarean, and 6878 (83.2%) delivered by a repeat cesarean birth. Having a repeat cesarean birth was negatively associated with a need for curettage (ARR 0.12 [0.06, 0.25]) but was positively associated with having a blood transfusion (ARR 3.74 [2.48, 5.63]). Having a repeat cesarean birth was negatively associated with stillbirth (ARR 0.24 [0.15, 0.49]) and, breast-feeding within an hour of birth (ARR 0.39 [0.30, 0.50]), but positively associated with use of antibiotics (ARR 1.51 [1.20, 1.91]). CONCLUSIONS In select South Asian and Latin American low- and middle-income sites, women with a history of prior cesarean birth were 5 times more likely to deliver by cesarean birth in the hospital setting. Those who delivered vaginally had less complicated pregnancy and labor courses compared to those who delivered by repeat cesarean birth, but they had an increased risk of stillbirth. More large scale studies are needed in Low Income Country settings to give stronger recommendations. TRIAL REGISTRATION NCT01073475, Registered February 21, 2010, https://clinicaltrials.gov/ct2/show/record/NCT01073475 .
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Affiliation(s)
- Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá -INCAP, Calzada Roosevelt 6-25 zona 11, C.A, Guatemala City, Guatemala.
| | - Margo Harrison
- University of Colorado School of Medicine, Denver, CO, USA
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y Panamá -INCAP, Calzada Roosevelt 6-25 zona 11, C.A, Guatemala City, Guatemala
| | | | - Avinash Kavi
- KLE University's Jawaharlal Nehru Medical College, Belgaum, India
| | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | | | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farnaz Naqvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
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16
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Kavi A, Hoffman MK, Somannavar MS, Metgud MC, Goudar SS, Moore J, Nielsen E, Goco N, McClure EM, Lokangaka A, Tshefu A, Bauserman M, Mwenechanya M, Chomba E, Carlo WA, Figueroa L, Krebs NF, Jessani S, Saleem S, Goldenberg RL, Das P, Patel A, Hibberd PL, Esamai F, Bucher S, Koso-Thomas M, Silver R, Derman RJ. Aspirin delays the onset of hypertensive disorders of pregnancy among nulliparous pregnant women: A secondary analysis of the ASPIRIN trial. BJOG 2023; 130 Suppl 3:16-25. [PMID: 37470099 PMCID: PMC10799162 DOI: 10.1111/1471-0528.17607] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To assess the impact of low-dose aspirin (LDA) starting in early pregnancy on delaying preterm hypertensive disorders of pregnancy. DESIGN Non-prespecified secondary analysis of a randomised masked trial of LDA. SETTING The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR) clusters, a prospective, population-based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Pakistan, India (two sites-Belagavi and Nagpur) and Guatemala. POPULATION Nulliparous singleton pregnancies between 6+0 weeks and 13+6 weeks in six low-middle income countries (Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, Zambia) enrolled in the ASPIRIN Trial. METHODS We compared the incidence of HDP at delivery at three gestational age periods (<28, <34 and <37 weeks) between women who were randomised to aspirin or placebo. Women were included if they were randomised and had an outcome at or beyond 20 weeks (Modified Intent to Treat). MAIN OUTCOME MEASURES Our primary outcome was pregnancies with HDP associated with preterm delivery (HDP@delivery) before <28, <34 and <37 weeks. Secondary outcomes included small for gestational age (SGA) <10th percentile, <5th percentile, and perinatal mortality. RESULTS Among the 11 976 pregnancies, LDA did not significantly lower HDP@delivery <28 weeks (relative risk [RR] 0.18, 95% confidence interval [CI] 0.02-1.52); however, it did lower HDP@delivery <34 weeks (RR 0.37, 95% CI 0.17-0.81) and HDP@delivery <37 weeks (RR 0.66, 95% CI 0.49-0.90). The overall rate of HDP did not differ between the two groups (RR 1.08, 95% CI 0.94-1.25). Among those pregnancies who had HDP, SGA <10th percentile was reduced (RR 0.81, 95% CI 0.67-0.99), though SGA <5th percentile was not (RR 0.84, 95% CI 0.64-1.09). Similarly, perinatal mortality among pregnancies with HDP occurred less frequently (RR 0.55, 95% CI 0.33-0.92) in those receiving LDA. Pregnancies randomised to LDA delivered later with HDP compared with those receiving placebo (median gestational age 38.5 weeks vs. 37.9 weeks; p = 0.022). CONCLUSIONS In this secondary analysis of a study of low-risk nulliparous singleton pregnancies, early administration of LDA resulted in lower rates of preterm HDP and delivery before 34 and 37 weeks but not in the overall rate of HDP. These results suggest that LDA works in part by delaying HDP.
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Affiliation(s)
- Avinash Kavi
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | | | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Mrityunjay C Metgud
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Janet Moore
- RTI International, Durham, North Carolina, USA
| | | | - Norman Goco
- RTI International, Durham, North Carolina, USA
| | | | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
| | | | | | | | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | - Fabian Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Sherri Bucher
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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17
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Kavi A, Goudar SS, Somannavar MS, Moore JL, Derman RJ, Saleem S, Naqvi S, Billah SM, Haque R, Figueroa L, Mazariegos M, Lokangaka A, Tshefu A, Esamai F, Mwenechanya M, Chomba E, Patel A, Das P, Bauserman M, Petri WA, Krebs NF, Carlo WA, Bucher S, Hibberd PL, Koso-Thomas M, McClure EM, Goldenberg RL. COVID-19 symptoms and antibody positivity among unvaccinated pregnant women: An observational study in seven countries from the Global Network. BJOG 2023; 130 Suppl 3:140-148. [PMID: 37470094 PMCID: PMC10799161 DOI: 10.1111/1471-0528.17604] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/24/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To determine the relation of COVID-19 symptoms to COVID-19 antibody positivity among unvaccinated pregnant women in low- and middle-income countries (LMIC). DESIGN COVID-19 infection status measured by antibody positivity at delivery was compared with the symptoms of COVID-19 in the current pregnancy in a prospective, observational cohort study in seven LMICs. SETTING The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR), a prospective, population-based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Bangladesh, Pakistan, India (Belagavi and Nagpur sites) and Guatemala. POPULATION Pregnant women enrolled in the ongoing pregnancy registry at study sites. METHODS Data on COVID-19 symptoms during the current pregnancy were collected by trained staff between October 2020 and June 2022. COVID-19 antibody testing was performed on samples collected at delivery. The relation between COVID-19 antibody positivity and symptoms was assessed using generalised linear models with a binomial distribution adjusting for site and symptoms. MAIN OUTCOME MEASURES COVID-19 antibody status and symptoms of COVID-19 among pregnant women. RESULTS Among 19 218 non-vaccinated pregnant women who were evaluated, 14.1% of antibody-positive women had one or more symptoms compared with 13.4% in antibody-negative women. Overall, 85.3% of antibody-positive women reported no COVID-19 symptoms during the present pregnancy. Reported fever was significantly associated with antibody status (relative risk [RR] 1.10, 95% CI 1.03-11.18; P = 0.008). A multiple variable model adjusting for site and all eight symptoms during pregnancy showed similar results (RR 1.13, 95% CI 1.04-1.23; P = 0.012). None of the other symptoms was significantly related to antibody positivity. CONCLUSIONS In a population-based cohort in LMICs, unvaccinated pregnant women who were antibody-positive had slightly more symptoms during their pregnancy and a small but significantly greater increase in fever. However, for prevalence studies, evaluating COVID-19-related symptoms does not appear to be useful in differentiating pregnant women who have had a COVID-19 infection.
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Affiliation(s)
- Avinash Kavi
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Janet L Moore
- Research Triangle Institute (RTI) International, Research Triangle Park, North Carolina, USA
| | | | | | | | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
- University of Sydney, Sydney, New South Wales, Australia
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Elwyn Chomba
- University of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical, Sciences, Sawangi, India
| | | | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Sherri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Elizabeth M McClure
- Research Triangle Institute (RTI) International, Research Triangle Park, North Carolina, USA
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18
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Jessani S, Saleem S, Fogleman E, Billah SM, Haque R, Figueroa L, Lokangaka A, Tshefu A, Goudar SS, Kavi A, Esamai F, Mwenchanya M, Chomba E, Patel A, Das P, Mazariegos M, Bauserman M, Petri WA, Krebs NF, Derman RJ, Carlo WA, Bucher S, Hibberd PL, Koso-Thomas M, Bann CM, McClure EM, Goldenberg RL. Trends over time in the knowledge, attitude and practices of pregnant women related to COVID-19: A cross-sectional survey from seven low- and middle-income countries. BJOG 2023; 130 Suppl 3:149-157. [PMID: 37581947 DOI: 10.1111/1471-0528.17630] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/21/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To understand trends in the knowledge, attitudes and practices (KAP) of pregnant women related to COVID-19 in seven low- and middle-income countries. DESIGN Multi-country population-based prospective observational study. SETTING Study sites in Bangladesh, the Demographic Republic of Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia. POPULATION Pregnant women in the Global Network's Maternal and Neonatal Health Registry (MNHR). METHODS Pregnant women enrolled in the MNHR were interviewed to assess their KAP related to COVID-19 from September 2020 through July 2022 across all study sites. MAIN OUTCOME MEASURES Trends of COVID-19 KAP were assessed using the Cochran-Armitage test for trend. RESULTS A total of 52 297 women participated in this study. There were wide inter-country differences in COVID-19-related knowledge. The level of knowledge of women in the DRC was much lower than that of women in the other sites. The ability to name COVID-19 symptoms increased over time in the African sites, whereas no such change was observed in Bangladesh, Belagavi and Guatemala. All sites observed decreasing trends over time in women avoiding antenatal care visits. CONCLUSIONS The knowledge and attitudes of pregnant women related to COVID-19 varied substantially among the Global Network sites over a period of 2 years; however, there was very little change in knowledge related to COVID-19 over time across these sites. The major change observed was that fewer women reported avoiding medical care because of COVID-19 across all sites over time.
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Affiliation(s)
| | | | | | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
- University of Sydney, Sydney, New South Wales, Australia
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, JN Medical College Belagavi, Belagavi, Karnataka, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, JN Medical College Belagavi, Belagavi, Karnataka, India
| | | | | | - Elwyn Chomba
- University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
- Datta Meghe Institute of Medical Sciences, Sawangi, Maharashtra, India
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
| | | | | | - Sherri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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19
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Naqvi S, Saleem S, Billah SM, Moore J, Mwenechanya M, Carlo WA, Esamai F, Bucher S, Derman RJ, Goudar SS, Somannavar M, Patel A, Hibberd PL, Figueroa L, Krebs NF, Petri WA, Lokangaka A, Bauserman M, Koso-Thomas M, McClure EM, Goldenberg RL. The Global Network COVID-19 studies: a review. BJOG 2023; 130 Suppl 3:134-139. [PMID: 37530467 DOI: 10.1111/1471-0528.17610] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
With the paucity of data available regarding COVID-19 in pregnancy in low- and middle-income countries (LMICs), near the start of the pandemic, the Global Network for Women's and Children's Health Research, funded by the National Institute of Child Health and Human Development (NICHD), initiated four separate studies to better understand the impact of the COVID-19 pandemic in eight LMIC sites. These sites included: four in Asia, in Bangladesh, India (two sites) and Pakistan; three in Africa, in the Democratic Republic of the Congo (DRC), Kenya and Zambia; and one in Central America, in Guatemala. The first study evaluated changes in health service utilisation; the second study evaluated knowledge, attitudes and practices of pregnant women in relationship to COVID-19 in pregnancy; the third study evaluated knowledge, attitude and practices related to COVID-19 vaccination in pregnancy; and the fourth study, using antibody status at delivery, evaluated changes in antibody status over time in each of the sites and the relationship of antibody positivity with various pregnancy outcomes. Across the Global Network, in the first year of the study there was little reduction in health care utilisation and no apparent change in pregnancy outcomes. Knowledge related to COVID-19 was highly variable across the sites but was generally poor. Vaccination rates among pregnant women in the Global Network were very low, and were considerably lower than the vaccination rates reported for the countries as a whole. Knowledge regarding vaccines was generally poor and varied widely. Most women did not believe the vaccines were safe or effective, but slightly more than half would accept the vaccine if offered. Based on antibody positivity, the rates of COVID-19 infection increased substantially in each of the sites over the course of the pandemic. Most pregnancy outcomes were not worse in women who were infected with COVID-19 during their pregnancies. We interpret the absence of an increase in adverse outcomes in women infected with COVID-19 to the fact that in the populations studied, most COVID-19 infections were either asymptomatic or were relatively mild.
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Affiliation(s)
| | | | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Janet Moore
- RTI International, Durham, North Carolina, USA
| | | | | | | | - Sherri Bucher
- Department of Pediatrics, Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Manjunath Somannavar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | | | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | | | - Adrien Lokangaka
- Department of Pediatrics, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York, USA
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20
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Nuss EE, Hoffman MK, Goudar SS, Kavi A, Metgud M, Somannavar M, Okitawutshu J, Lokangaka A, Tshefu A, Bauserman M, Tembo AM, Chomba E, Carlo WA, Figueroa L, Krebs NF, Jessani S, Saleem S, Goldenberg RL, Kurhe K, Das P, Hibberd PL, Achieng E, Nyongesa P, Esamai F, Liechty EA, Bucher S, Goco N, Hemingway-Foday J, Moore J, McClure EM, Silver RM, Derman RJ. The impact of risk factors on aspirin's efficacy for the prevention of preterm birth. Am J Obstet Gynecol MFM 2023; 5:101095. [PMID: 37574046 DOI: 10.1016/j.ajogmf.2023.101095] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The Aspirin Supplementation for Pregnancy Indicated Risk Reduction In Nulliparas trial was a landmark study that demonstrated a reduction in preterm birth and hypertensive disorders of pregnancy in nulliparous women who received low-dose aspirin. All women in the study had at least 1 moderate-risk factor for preeclampsia (nulliparity). Unlike current US Preventative Service Task Force guidelines, which recommend low-dose aspirin for ≥2 moderate-risk factors, women in this study were randomized to receive low-dose aspirin regardless of the presence or absence of an additional risk factor. OBJECTIVE This study aimed to compare how low-dose aspirin differentially benefits nulliparous women with and without additional preeclampsia risk factors for the prevention of preterm birth and hypertensive disorders of pregnancy. STUDY DESIGN This was a non-prespecified secondary analysis of the Aspirin Supplementation for Pregnancy Indicated Risk Reduction In Nulliparas trial that randomized nulliparous women with singleton pregnancies from 6 low-middle-income countries to receive low-dose aspirin or placebo. Our primary exposure was having an additional preeclampsia risk factor beyond nulliparity. Our primary outcome was preterm birth before 37 weeks of gestation, and our secondary outcomes included preterm birth before 34 weeks of gestation, preterm birth before 28 weeks of gestation, hypertensive disorders of pregnancy, and perinatal mortality. RESULTS Among 11,558 nulliparous women who met the inclusion criteria, 66.8% had no additional risk factors. Low-dose aspirin similarly reduced the risk of preterm birth at <37 weeks of gestation in women with and without additional risk factors (relative risk: 0.75 vs 0.85; P=.35). Additionally for our secondary outcomes, low-dose aspirin similarly reduced the risk of preterm birth at <28 weeks of gestation, hypertensive disorders of pregnancy, and perinatal mortality in women with and without additional risk factors. The reduction of preterm birth at <34 weeks of gestation with low-dose aspirin was significantly greater in women without additional risk factors than those with an additional risk factor (relative risk: 0.69 vs 1.04; P=.04). CONCLUSION Low-dose aspirin's ability to prevent preterm birth, hypertensive disorders of pregnancy, and perinatal mortality was similar in nulliparous women with and without additional risk factors. Professional societies should consider recommending low-dose aspirin to all nulliparous women.
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Affiliation(s)
- Emily E Nuss
- Christiana Care, Newark, DE (Drs Nuss and Hoffman).
| | | | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, India (Drs Goudar, Kavi, Metgud, and Somannavar)
| | - Avinash Kavi
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, India (Drs Goudar, Kavi, Metgud, and Somannavar)
| | - Mrityunjay Metgud
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, India (Drs Goudar, Kavi, Metgud, and Somannavar)
| | - Manjunath Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, India (Drs Goudar, Kavi, Metgud, and Somannavar)
| | - Jean Okitawutshu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (Drs Okitawutshu, Lokangaka, and Tshefu)
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (Drs Okitawutshu, Lokangaka, and Tshefu)
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo (Drs Okitawutshu, Lokangaka, and Tshefu)
| | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, NC (Dr Bauserman)
| | | | - Elwyn Chomba
- University Teaching Hospital, Lusaka, Zambia (Ms Tembo and Dr Chomba)
| | | | - Lester Figueroa
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala (Dr Figueroa)
| | - Nancy F Krebs
- University of Colorado Denver, Denver, CO (Dr Krebs)
| | - Saleem Jessani
- Aga Khan University, Karachi, Pakistan (Drs Jessani and Saleem)
| | - Sarah Saleem
- Aga Khan University, Karachi, Pakistan (Drs Jessani and Saleem)
| | | | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India (Drs Kurhe and Das)
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, India (Drs Kurhe and Das)
| | | | - Emmah Achieng
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya (Ms Achieng and Drs Nyongesa and Esamai)
| | - Paul Nyongesa
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya (Ms Achieng and Drs Nyongesa and Esamai)
| | - Fabian Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya (Ms Achieng and Drs Nyongesa and Esamai)
| | - Edward A Liechty
- School of Medicine, Indiana University, Indianapolis, IN (Drs Liechty and Bucher)
| | - Sherri Bucher
- School of Medicine, Indiana University, Indianapolis, IN (Drs Liechty and Bucher)
| | - Norman Goco
- RTI International, Research Triangle Park, NC (Mr Goco, Mses Hemingway-Foday and Moore, and Dr McClure)
| | - Jennifer Hemingway-Foday
- RTI International, Research Triangle Park, NC (Mr Goco, Mses Hemingway-Foday and Moore, and Dr McClure)
| | - Janet Moore
- RTI International, Research Triangle Park, NC (Mr Goco, Mses Hemingway-Foday and Moore, and Dr McClure)
| | - Elizabeth M McClure
- RTI International, Research Triangle Park, NC (Mr Goco, Mses Hemingway-Foday and Moore, and Dr McClure)
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21
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Patel A, Bann CM, Thorsten VR, Rao SR, Lokangaka A, Tshefu Kitoto A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Bucher S, Saleem S, Goldenberg RL, Chomba E, Carlo WA, Goudar S, Derman R, Koso-Thomas M, McClure E, Hibberd PL. Can the date of last menstrual period be trusted in the first trimester? Comparisons of gestational age measures from a prospective cohort study in six low-income to middle-income countries. BMJ Open 2023; 13:e067470. [PMID: 37730415 PMCID: PMC10514667 DOI: 10.1136/bmjopen-2022-067470] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 07/26/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVES We examined gestational age (GA) estimates for live and still births, and prematurity rates based on last menstrual period (LMP) compared with ultrasonography (USG) among pregnant women at seven sites in six low-resource countries. DESIGN Prospective cohort study SETTING AND PARTICIPANTS: This study included data from the Global Network's population-based Maternal and Newborn Health Registry which follows pregnant women in six low-income and middle-income countries (Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan and Zambia). Participants in this analysis were 42 803 women, including their 43 230 babies, who registered for the study in their first trimester based on GA estimated either by LMP or USG and had a live or stillbirth with an estimated GA of 20-42 weeks. OUTCOME MEASURES GA was estimated in weeks and days based on LMP and/or USG. Prematurity was defined as GA of 20 weeks+0 days through 36 weeks+6 days, calculated by both USG and LMP. RESULTS Overall, average GA varied ≤1 week between LMP and USG. Mean GA for live births by LMP was lower than by USG (adjusted mean difference (95% CI) = -0.23 (-0.29 to -0.17) weeks). Among stillbirths, a higher GA was estimated by LMP than USG (adjusted mean difference (95% CI)= 0.42 (0.11 to 0.72) weeks). Preterm birth rates for live births were significantly higher when dated by LMP (adjusted rate difference (95% CI)= 4.20 (3.56 to 4.85)). There was no significant difference in preterm birth rates for stillbirths. CONCLUSION The small differences in GA for LMP versus USG in the Guatemalan and Indian sites suggest that LMP may be a useful alternative to USG for GA dating during the first trimester until availability of USG improves in those areas. Further research is needed to assess LMP for first-trimester GA dating in other regions with limited access to USG. TRIAL REGISTRATION NUMBER NCT01073475.
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Affiliation(s)
- Archana Patel
- Lata Medical Research Foundation, Nagpur, Nagpur, Maharashtra, India
| | - Carla M Bann
- Statistics Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Vanessa R Thorsten
- Statistics Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Sowmya R Rao
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Adrien Lokangaka
- School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Antoinette Tshefu Kitoto
- School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Melissa Bauserman
- School of Medicine, University of North Carolina, Chapel Hill, Carolina, USA
| | - Lester Figueroa
- Institute of Nutrition of Central America and Panama, Guatemala, Guatemala, Guatemala
| | - Nancy F Krebs
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Fabian Esamai
- Alupe University College, Busia, Western Kenya, Kenya
| | - Sherri Bucher
- Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Elwyn Chomba
- University of Zambia University Teaching Hospital, Lusaka, Lusaka, Zambia
| | - Waldemar A Carlo
- Division of Neonatology, University of Alabama at Birmingham Department of Pediatrics, Birmingham, Alabama, USA
| | - Shivaprasad Goudar
- Women's and Children's Health Research Unit, J N Medical College Belagavi, Belagavi, Karnataka, India
| | - Richard Derman
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Elizabeth McClure
- Statistics Division, RTI International, Research Triangle Park, North Carolina, USA
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22
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Odiase E, Frank DN, Young BE, Robertson CE, Kofonow JM, Davis KN, Berman LM, Krebs NF, Tang M. The Gut Microbiota Differ in Exclusively Breastfed and Formula-Fed United States Infants and are Associated with Growth Status. J Nutr 2023; 153:2612-2621. [PMID: 37506974 PMCID: PMC10517231 DOI: 10.1016/j.tjnut.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Evidence regarding the effects of infant feeding type (exclusive breastfeeding compared with exclusive formula feeding) on the gut microbiota and how it impacts infant growth status is limited. OBJECTIVES The primary objective was to compare gut microbiota by feeding type and characterize the associations between gut microbiota and infant growth status. METHODS Stool samples from healthy, full-term infants (4-5 mo-old) who were either exclusively breastfed (BF) or exclusively formula-fed (FF) in Denver, CO, United States were collected, and fecal 16S ribosomal ribonucleic acid gene-based profiling was conducted. Length and weight were measured at the time of stool collection. Length-for-age z-score, weight-for-age z-scores (WAZ), and weight-for-length z-scores were calculated based on the World Health Organization standards. Associations between gut microbial taxa and anthropometric z-scores were assessed by Spearman's rank correlation test. RESULTS A total of 115 infants (BF n = 54; FF n = 61) were included in this study. Feeding type (BF compared with FF) was the most significant tested variable on gut microbiota composition (P < 1 × 10-⁶), followed by mode of delivery and race. Significant differences were observed in α-diversity, β-diversity, and relative abundances of individual taxa between BF and FF. BF infants had lower α-diversity than FF infants. Abundances of Bifidobacterium and Lactobacillus were greater in the breastfeeding group. FF infants had a higher relative abundance of unclassified Ruminococcaceae (P < 0.001), which was associated with a higher WAZ (P < 0.001) and length-for-age z-score (P < 0.01). Lactobacillus was inversely associated with WAZ (P < 0.05). CONCLUSIONS Feeding type is the main driver of gut microbiota differences in young infants. The gut microbiota differences based on feeding type (exclusive breast- or formula feeding) were associated with observed differences in growth status. This trial was registered at clinicaltrials.gov as NCT02142647, NCT01693406, and NCT04137445.
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Affiliation(s)
- Eunice Odiase
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, 22904, USA
| | - Daniel N Frank
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bridget E Young
- University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Charles E Robertson
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jennifer M Kofonow
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kathryn N Davis
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Lillian M Berman
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Minghua Tang
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
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23
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Hemingway-Foday J, Tita A, Chomba E, Mwenechanya M, Mweemba T, Nolen T, Lokangaka A, Tshefu Kitoto A, Lomendje G, Hibberd PL, Patel A, Das PK, Kurhe K, Goudar SS, Kavi A, Metgud M, Saleem S, Tikmani SS, Esamai F, Nyongesa P, Sagwe A, Figueroa L, Mazariegos M, Billah SM, Haque R, Shahjahan Siraj M, Goldenberg RL, Bauserman M, Bose C, Liechty EA, Ekhaguere OA, Krebs NF, Derman R, Petri WA, Koso-Thomas M, McClure E, Carlo WA. Prevention of maternal and neonatal death/infections with a single oral dose of azithromycin in women in labour in low-income and middle-income countries (A-PLUS): a study protocol for a multinational, randomised placebo-controlled clinical trial. BMJ Open 2023; 13:e068487. [PMID: 37648383 PMCID: PMC10471878 DOI: 10.1136/bmjopen-2022-068487] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/15/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Maternal and neonatal infections are among the most frequent causes of maternal and neonatal mortality, and current antibiotic strategies have been ineffective in preventing many of these deaths. A randomised clinical trial conducted in a single site in The Gambia showed that treatment with an oral dose of 2 g azithromycin versus placebo for all women in labour reduced certain maternal and neonatal infections. However, it is unknown if this therapy reduces maternal and neonatal sepsis and mortality. In a large, multinational randomised trial, we will evaluate the impact of azithromycin given in labour to improve maternal and newborn outcomes. METHODS AND ANALYSIS This randomised, placebo-controlled, multicentre clinical trial includes two primary hypotheses, one maternal and one neonatal. The maternal hypothesis is to test whether a single, prophylactic intrapartum oral dose of 2 g azithromycin given to women in labour will reduce maternal death or sepsis. The neonatal hypothesis will test whether this intervention will reduce intrapartum/neonatal death or sepsis. The intervention is a single, prophylactic intrapartum oral dose of 2 g azithromycin, compared with a single intrapartum oral dose of an identical appearing placebo. A total of 34 000 labouring women from 8 research sites in sub-Saharan Africa, South Asia and Latin America will be randomised with a one-to-one ratio to intervention/placebo. In addition, we will assess antimicrobial resistance in a sample of women and their newborns. ETHICS AND DISSEMINATION The study protocol has been reviewed and ethics approval obtained from all the relevant ethical review boards at each research site. The results will be disseminated via peer-reviewed journals and national and international scientific forums. TRIAL REGISTRATION NUMBER NCT03871491 (https://clinicaltrials.gov/ct2/show/NCT03871491?term=NCT03871491&draw=2&rank=1).
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Affiliation(s)
| | - Alan Tita
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Elwyn Chomba
- University of Zambia, University Teaching Hospital, Lusaka, Zambia
| | | | - Trecious Mweemba
- University of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - Tracy Nolen
- RTI International, Research Triangle Park, North Carolina, USA
| | - Adrien Lokangaka
- University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | - Antoinette Tshefu Kitoto
- University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | - Gustave Lomendje
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
- Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, Maharashtra, India
| | | | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgavi, Karnataka, India
| | - Avinash Kavi
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgavi, Karnataka, India
| | - Mrityunjay Metgud
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgavi, Karnataka, India
| | - Sarah Saleem
- Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Shiyam S Tikmani
- Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | | | | | - Amos Sagwe
- Moi University School of Medicine, Eldoret, Kenya
| | - Lester Figueroa
- Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Manolo Mazariegos
- Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Sk Masum Billah
- The University of Sydney, Sydney, New South Wales, Australia
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Md Shahjahan Siraj
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Melissa Bauserman
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Carl Bose
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Edward A Liechty
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Richard Derman
- Office of Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | | | - Waldemar A Carlo
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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24
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Patterson JK, Thorsten VR, Eggleston B, Nolen T, Lokangaka A, Tshefu A, Goudar SS, Derman RJ, Chomba E, Carlo WA, Mazariegos M, Krebs NF, Saleem S, Goldenberg RL, Patel A, Hibberd PL, Esamai F, Liechty EA, Haque R, Petri B, Koso-Thomas M, McClure EM, Bose CL, Bauserman M. Building a predictive model of low birth weight in low- and middle-income countries: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:600. [PMID: 37608358 PMCID: PMC10464177 DOI: 10.1186/s12884-023-05866-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Low birth weight (LBW, < 2500 g) infants are at significant risk for death and disability. Improving outcomes for LBW infants requires access to advanced neonatal care, which is a limited resource in low- and middle-income countries (LMICs). Predictive modeling might be useful in LMICs to identify mothers at high-risk of delivering a LBW infant to facilitate referral to centers capable of treating these infants. METHODS We developed predictive models for LBW using the NICHD Global Network for Women's and Children's Health Research Maternal and Newborn Health Registry. This registry enrolled pregnant women from research sites in the Democratic Republic of the Congo, Zambia, Kenya, Guatemala, India (2 sites: Belagavi, Nagpur), Pakistan, and Bangladesh between January 2017 - December 2020. We tested five predictive models: decision tree, random forest, logistic regression, K-nearest neighbor and support vector machine. RESULTS We report a rate of LBW of 13.8% among the eight Global Network sites from 2017-2020, with a range of 3.8% (Kenya) and approximately 20% (in each Asian site). Of the five models tested, the logistic regression model performed best with an area under the curve of 0.72, an accuracy of 61% and a recall of 72%. All of the top performing models identified clinical site, maternal weight, hypertensive disorders, severe antepartum hemorrhage and antenatal care as key variables in predicting LBW. CONCLUSIONS Predictive modeling can identify women at high risk for delivering a LBW infant with good sensitivity using clinical variables available prior to delivery in LMICs. Such modeling is the first step in the development of a clinical decision support tool to assist providers in decision-making regarding referral of these women prior to delivery. Consistent referral of women at high-risk for delivering a LBW infant could have extensive public health consequences in LMICs by directing limited resources for advanced neonatal care to the infants at highest risk.
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Affiliation(s)
- Jackie K Patterson
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr, Chapel Hill, NC, 27514, USA.
| | | | | | - Tracy Nolen
- RTI International, Research Triangle Park, Durham, NC, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Richard J Derman
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Manolo Mazariegos
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Nancy F Krebs
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur & Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | - Fabian Esamai
- Department of Child Health and Paediatrics, School of Medicine, Moi University, Eldoret, Kenya
| | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Bill Petri
- Division of Infectious Diseases, University of Virginia, Charlottesville, VA, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - Carl L Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr, Chapel Hill, NC, 27514, USA
| | - Melissa Bauserman
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr, Chapel Hill, NC, 27514, USA
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25
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Uffelman CN, Doenges KA, Armstrong ML, Quinn K, Reisdorph RM, Tang M, Krebs NF, Reisdorph NA, Campbell WW. Metabolomics Profiling of White Button, Crimini, Portabella, Lion's Mane, Maitake, Oyster, and Shiitake Mushrooms Using Untargeted Metabolomics and Targeted Amino Acid Analysis. Foods 2023; 12:2985. [PMID: 37627983 PMCID: PMC10453450 DOI: 10.3390/foods12162985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Mushrooms contain multiple essential nutrients and health-promoting bioactive compounds, including the amino acid L-ergothioneine. Knowledge of the chemical composition of different mushroom varieties will aid research on their health-promoting properties. We compared the metabolomes of fresh raw white button, crimini, portabella, lion's mane, maitake, oyster, and shiitake mushrooms using untargeted liquid chromatography mass spectrometry (LC/MS)-based metabolomics. We also quantified amino acid concentrations, including L-ergothioneine, a potential antioxidant which is not synthesized by plants or animals. Among the seven mushroom varieties, more than 10,000 compounds were detected. Principal Component Analysis indicated mushrooms of the same species, Agaricus Bisporus (white button, portabella, crimini), group similarly. The other varieties formed individual, distinct clusters. A total of 1344 (520 annotated) compounds were detected in all seven mushroom varieties. Each variety had tens-to-hundreds of unique-to-mushroom-variety compounds. These ranged from 29 for crimini to 854 for lion's mane. All three Agaricus bisporus varieties had similar amino acid profiles (including detection of all nine essential amino acids), while other varieties had less methionine and tryptophan. Lion's mane and oyster mushrooms had the highest concentrations of L-ergothioneine. The detection of hundreds of unique-to-mushroom-variety compounds emphasizes the differences in chemical composition of these varieties of edible fungi.
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Affiliation(s)
- Cassi N. Uffelman
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
| | - Katrina A. Doenges
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (K.A.D.); (M.L.A.); (K.Q.); (R.M.R.); (N.A.R.)
| | - Michael L. Armstrong
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (K.A.D.); (M.L.A.); (K.Q.); (R.M.R.); (N.A.R.)
| | - Kevin Quinn
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (K.A.D.); (M.L.A.); (K.Q.); (R.M.R.); (N.A.R.)
| | - Richard M. Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (K.A.D.); (M.L.A.); (K.Q.); (R.M.R.); (N.A.R.)
| | - Minghua Tang
- School of Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (M.T.); (N.F.K.)
| | - Nancy F. Krebs
- School of Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (M.T.); (N.F.K.)
| | - Nichole A. Reisdorph
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (K.A.D.); (M.L.A.); (K.Q.); (R.M.R.); (N.A.R.)
| | - Wayne W. Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
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26
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Fernandes M, Krebs NF, Westcott J, Tshefu A, Lokangaka A, Bauserman M, Garcés AL, Figueroa L, Saleem S, Aziz SA, Goldenberg RL, Goudar SS, Dhaded SM, Derman RJ, Kemp JF, Koso-Thomas M, Sridhar A, M McClure E, Hambidge KM. Neurodevelopment, vision and auditory outcomes at age 2 years in offspring of participants in the 'Women First' maternal preconception nutrition randomised controlled trial. Arch Dis Child 2023; 108:622-631. [PMID: 37142335 PMCID: PMC10423475 DOI: 10.1136/archdischild-2023-325352] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Maternal nutrition in preconception and early pregnancy influences fetal growth. Evidence for effects of prenatal maternal nutrition on early child development (ECD) in low-income and middle-income countries is limited. OBJECTIVES To examine impact of maternal nutrition supplementation initiated prior to or during pregnancy on ECD, and to examine potential association of postnatal growth with ECD domains. DESIGN Secondary analysis regarding the offspring of participants of a maternal multicountry, individually randomised trial. SETTING Rural Democratic Republic of the Congo, Guatemala, India and Pakistan. PARTICIPANTS 667 offspring of Women First trial participants, aged 24 months. INTERVENTION Maternal lipid-based nutrient supplement initiated preconceptionally (arm 1, n=217), 12 weeks gestation (arm 2, n=230) or not (arm 3, n=220); intervention stopped at delivery. MAIN OUTCOME MEASURES The INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) cognitive, language, gross motor, fine motor, positive and negative behaviour scores; visual acuity and contrast sensitivity scores and auditory evoked response potentials (ERP). Anthropometric z-scores, family care indicators (FCI) and sociodemographic variables were examined as covariates. RESULTS No significant differences were detected among the intervention arms for any INTER-NDA scores across domains, vision scores or ERP potentials. After adjusting for covariates, length-for-age z-score at 24 months (LAZ24), socio-economic status, maternal education and FCI significantly predicted vision and INTER-NDA scores (R2=0.11-0.38, p<0.01). CONCLUSIONS Prenatal maternal nutrition supplementation was not associated with any neurodevelopmental outcomes at age 2 years. Maternal education, family environment and LAZ24 predicted ECD. Interventions addressing multiple components of the nurturing care model may offer greatest impact on children's developmental potential. TRIAL REGISTRATION NUMBER NCT01883193.
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Affiliation(s)
- Michelle Fernandes
- MRC Lifecourse Epidemiology Centre and Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Nancy F Krebs
- Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Jamie Westcott
- Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, The Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, The Democratic Republic of the Congo
| | - Melissa Bauserman
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Ana L Garcés
- Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Lester Figueroa
- Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Sarah Saleem
- Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sumera A Aziz
- Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research (Deemed-to-be-University) Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research (Deemed-to-be-University) Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | | | - Jennifer F Kemp
- Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | | | | | - K Michael Hambidge
- Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
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27
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Namazzi R, Opoka R, Conroy AL, Datta D, Tagoola A, Bond C, Goings MJ, Ryu MS, Cusick SE, Krebs NF, Jang JH, Tu W, Ware RE, John CC. Zinc for infection prevention in children with sickle cell anemia: a randomized double-blind placebo-controlled trial. Blood Adv 2023; 7:3023-3031. [PMID: 36735400 PMCID: PMC10331409 DOI: 10.1182/bloodadvances.2022008539] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023] Open
Abstract
Data from small clinical trials in the United States and India suggest zinc supplementation reduces infection in adolescents and adults with sickle cell anemia (SCA), but no studies of zinc supplementation for infection prevention have been conducted in children with SCA living in Africa. We conducted a randomized double-blind placebo-controlled trial to assess zinc supplementation for prevention of severe or invasive infections in Ugandan children 1.00-4.99 years with SCA. Of 252 enrolled participants, 124 were assigned zinc (10 mg) and 126 assigned placebo once daily for 12 months. The primary outcome was incidence of protocol-defined severe or invasive infections. Infection incidence did not differ between treatment arms (282 vs. 270 severe or invasive infections per 100 person-years, respectively, incidence rate ratio of 1.04 [95% confidence interval (CI), 0.81, 1.32, p=0.78]), adjusting for hydroxyurea treatment. There was also no difference between treatment arms in incidence of serious adverse events or SCA-related events. Children receiving zinc had increased serum levels after 12-months, but at study exit, 41% remained zinc deficient (<65 μg/dL). In post-hoc analysis, occurrence of stroke or death was lower in the zinc treatment arm (adjusted hazard ratio (95% CI), 0.22 (0.05, 1.00); p=0.05). Daily 10 mg zinc supplementation for 12 months did not prevent severe or invasive infections in Ugandan children with SCA, but many supplemented children remained zinc deficient. Optimal zinc dosing and the role of zinc in preventing stroke or death in SCA warrant further investigation. This trial was registered at clinicaltrials.gov as #NCT03528434.
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Affiliation(s)
- Ruth Namazzi
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
| | - Robert Opoka
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
| | - Andrea L. Conroy
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Dibyadyuti Datta
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Abner Tagoola
- Department of Pediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Caitlin Bond
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Michael J. Goings
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Moon-Suhn Ryu
- Department of Food and Nutrition, Yonsei University, Seoul, Republic of Korea
| | - Sarah E. Cusick
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Nancy F. Krebs
- Department of Pediatrics, University of Colorado, Aurora, CO
| | - Jeong Hoon Jang
- Underwood International College and Department of Applied Statistics, Yonsei University, Seoul, Republic of Korea
| | - Wanzhu Tu
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Russell E. Ware
- Division of Hematology and Global Health Center, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Chandy C. John
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Goh YE, Manger MS, Duggal M, Das R, Saklani S, Agarwal S, Budhija D, Jamwal M, Singh BL, Dahiya N, Luo H, Long JM, Westcott J, Krebs NF, Gibson RS, Brown KH, McDonald CM. Women in Selected Communities of Punjab, India Have a High Prevalence of Iron, Zinc, Vitamin B12, and Folate Deficiencies: Implications for a Multiply-Fortified Salt Intervention. Nutrients 2023; 15:3024. [PMID: 37447352 DOI: 10.3390/nu15133024] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Dietary intake and biomarkers of micronutrient status of 100 non-pregnant women of reproductive age (NPWRA) were assessed to determine optimal levels of iron, zinc, vitamin B12, and folic acid to include in multiply-fortified salt (MFS) that will be evaluated in an upcoming trial. Weighed food records were obtained from participants to measure intake of micronutrients and discretionary salt, and to assess adequacy using Indian Nutrient Reference Values (NRVs). Statistical modeling was used to determine optimal fortification levels to reduce inadequate micronutrient intake while limiting intake above the upper limit. Fasting blood samples were obtained to assess iron, zinc, vitamin B12, and folate status. In usual diets, inadequate intake of iron (46%), zinc (95%), vitamin B12 (83%), and folate (36%) was high. Mean intake of discretionary salt was 4.7 g/day. Prevalence estimates of anemia (37%), iron deficiency (67%), zinc deficiency (34%), vitamin B12 insufficiency (37%), and folate insufficiency (70%) were also high. Simulating the addition of optimized MFS to usual diets resulted in percentage point (pp) reductions in inadequate intake by 29 pp for iron, 76 pp for zinc, 81 pp for vitamin B12, and 36 pp for folate. MFS holds potential to reduce the burden of micronutrient deficiencies in this setting.
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Affiliation(s)
- Yvonne E Goh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, CA 94609, USA
- International Zinc Nutrition Consultative Group, San Francisco, CA 94609, USA
| | - Mari S Manger
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, CA 94609, USA
- International Zinc Nutrition Consultative Group, San Francisco, CA 94609, USA
| | - Mona Duggal
- Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Reena Das
- Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Shipra Saklani
- Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Surbhi Agarwal
- Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Deepmala Budhija
- Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Manu Jamwal
- Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Bidhi L Singh
- Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Neha Dahiya
- Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Hanqi Luo
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Julie M Long
- Department of Pediatrics-Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Jamie Westcott
- Department of Pediatrics-Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nancy F Krebs
- International Zinc Nutrition Consultative Group, San Francisco, CA 94609, USA
- Department of Pediatrics-Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand
| | - Kenneth H Brown
- International Zinc Nutrition Consultative Group, San Francisco, CA 94609, USA
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
| | - Christine M McDonald
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California, San Francisco, CA 94609, USA
- International Zinc Nutrition Consultative Group, San Francisco, CA 94609, USA
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
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29
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Thompson DA, Haemer MA, Krebs NF, Pereira RI, Moss A, Furniss AL, Bonczynski J, Nicklas JM. A WIC-Based Behavior Change Intervention for Postpartum Women With Overweight and Obesity: A Pilot Feasibility Randomized Trial. Health Promot Pract 2023:15248399231173704. [PMID: 37226873 PMCID: PMC10674029 DOI: 10.1177/15248399231173704] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Background. Postpartum weight retention is a risk factor for obesity and is particularly important among Hispanic women who have an increased rate of obesity. Given its broad reach, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides an ideal setting to implement community-based interventions for low-income postpartum women. Purpose. To examine the feasibility, acceptability, and preliminary efficacy of a multicomponent intervention delivered by staff within the WIC program designed to promote behavior changes in urban, postpartum women with overweight/obesity. Method. This was a 12-week pilot trial randomizing participants to a health behavior change (Intervention) or control (Observation) group. The Intervention included monthly visits with trained WIC staff providing patient-centered behavior change counseling, with multiple touchpoints between visits promoting self-monitoring and offering health behavior change support. Results. Participants (n = 41), who were mainly Hispanic (n = 37, 90%) and Spanish-speaking (n = 33, 81%), were randomized to the Intervention (n = 19) or Observation (n = 22) group. In the Intervention group, 79% (n = 15) of eligible participants were retained for the study duration. All Intervention participants endorsed that they would participate again. Regarding physical activity, participant readiness to change and self-efficacy improved for Intervention participants. About one-quarter of women in the Intervention group (27%, n = 4) had a 5% weight loss compared with one woman (5%) in the Observation group; this difference was not statistically significant (p = .10). Conclusions. This pilot demonstrated the feasibility and acceptability of delivering a low-intensity behavior change intervention within the WIC setting for postpartum women with overweight/obesity. Findings support the role of WIC in addressing postpartum obesity.
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Affiliation(s)
- Darcy A Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Matthew A Haemer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Rocio I Pereira
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Angela Moss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Anna L Furniss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Jacinda M Nicklas
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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Manasyan A, Salas AA, Nolen T, Chomba E, Mazariegos M, Tshefu Kitoto A, Saleem S, Naqvi F, Hambidge KM, Goco N, McClure EM, Wallander JL, Biasini FJ, Goldenberg RL, Bose CL, Koso-Thomas M, Krebs NF, Carlo WA. Diagnostic accuracy of ASQ for screening of neurodevelopmental delays in low resource countries. BMJ Open 2023; 13:e065076. [PMID: 37221030 PMCID: PMC10230914 DOI: 10.1136/bmjopen-2022-065076] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 04/29/2023] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE The Bayley Scales of Infant Development (BSID) is the most used diagnostic tool to identify neurodevelopmental disorders in children under age 3 but is challenging to use in low-resource countries. The Ages and Stages Questionnaire (ASQ) is an easy-to-use, low-cost clinical tool completed by parents/caregivers that screens children for developmental delay. The objective was to determine the performance of ASQ as a screening tool for neurodevelopmental impairment when compared with BSID second edition (BSID-II) for the diagnosis of moderate-to-severe neurodevelopmental impairment among infants at 12 and 18 months of age in low-resource countries. METHODS Study participants were recruited as part of the First Bites Complementary Feeding trial from the Democratic Republic of Congo, Zambia, Guatemala and Pakistan between October 2008 and January 2011. Study participants underwent neurodevelopmental assessment by trained personnel using the ASQ and BSID-II at 12 and 18 months of age. RESULTS Data on both ASQ and BSID-II assessments of 1034 infants were analysed. Four of five ASQ domains had specificities greater than 90% for severe neurodevelopmental delay at 18 months of age. Sensitivities ranged from 23% to 62%. The correlations between ASQ communications subscale and BSID-II Mental Development Index (MDI) (r=0.38) and between ASQ gross motor subscale and BSID-II Psychomotor Development Index (PDI) (r=0.33) were the strongest correlations found. CONCLUSION At 18 months, ASQ had high specificity but moderate-to-low sensitivity for BSID-II MDI and/or PDI <70. ASQ, when administered by trained healthcare workers, may be a useful screening tool to detect severe disability in infants from rural low-income to middle-income settings. TRIAL REGISTRATION NUMBER NCT01084109.
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Affiliation(s)
- Albert Manasyan
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
- Department of Reproductive, Maternal, Newborn, and Child Health, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ariel A Salas
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Tracy Nolen
- Research Triangle Institute, Durham, North Carolina, USA
| | - Elwyn Chomba
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
- University of Zambia, Lusaka, Zambia
| | - Manolo Mazariegos
- Institute of Nutrition for Central America and Panamá (INCAP), Guatemala City, Panama
| | | | | | | | - K Michael Hambidge
- University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Norman Goco
- Research Triangle Institute, Durham, North Carolina, USA
| | | | - Jan L Wallander
- Psychological Sciences and Health Sciences Research Institute, University of California Merced, Merced, California, USA
| | - Fred J Biasini
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, UK
| | - Carl L Bose
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Nancy F Krebs
- University of Colorado Denver, Denver, Colorado, USA
| | - Waldemar A Carlo
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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31
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Gilley SP, Harrall KK, Friedman C, Glueck DH, Cohen CC, Perng W, Sauder KA, Krebs NF, Shankar K, Dabelea D. Association of Maternal BMI and Rapid Infant Weight Gain With Childhood Body Size and Composition. Pediatrics 2023; 151:e2022059244. [PMID: 37016999 PMCID: PMC11033707 DOI: 10.1542/peds.2022-059244] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES Maternal prepregnancy BMI (ppBMI) and an infant's rapid weight gain (RWG) are each associated with increased risk for childhood obesity. We hypothesized that ppBMI and RWG interact to further raise childhood obesity risk. METHODS Mother-infant dyads (n = 414) from the Healthy Start Study, an observational prebirth cohort, were included. RWG was defined as a weight-for-age z score increase of ≥0.67 from birth to 3 to 7 months. Body composition was measured by air displacement plethysmography at age 4 to 7 years. General linear regression models were fit to characterize associations between ppBMI, RWG, and their interaction with the outcomes of childhood BMI-for-age z score and percent fat mass (%FM). RESULTS A total of 18.6% (n = 77) of offspring experienced RWG. Maternal ppBMI and RWG were both positively associated with offspring BMI z score and %FM. RWG amplified the association between ppBMI and BMI z score, especially among females. Females exposed to maternal obesity and RWG had an average BMI at the 94th percentile (1.50 increase in childhood BMI z score) compared with those exposed to normal ppBMI and no RWG (average childhood BMI at the 51st percentile). RWG had a weaker effect on the association between ppBMI and %FM. Adjustment for breastfeeding status or childhood daily caloric intake did not significantly alter findings. CONCLUSIONS Rapid infant weight gain interacts with maternal ppBMI to jointly exacerbate risk of childhood obesity. Pediatric providers should monitor infants for RWG, especially in the context of maternal obesity, to reduce future risk of obesity.
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Affiliation(s)
- Stephanie P. Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
| | - Kylie K. Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Chloe Friedman
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Deborah H. Glueck
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Catherine C. Cohen
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado
| | - Katherine A. Sauder
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
| | - Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Dana Dabelea
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado
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32
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Krebs NF, Belfort MB, Meier PP, Mennella JA, O'Connor DL, Taylor SN, Raiten DJ. Infant factors that impact the ecology of human milk secretion and composition-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 3. Am J Clin Nutr 2023; 117 Suppl 1:S43-S60. [PMID: 37173060 PMCID: PMC10356564 DOI: 10.1016/j.ajcnut.2023.01.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/08/2022] [Accepted: 01/03/2023] [Indexed: 05/15/2023] Open
Abstract
Infants drive many lactation processes and contribute to the changing composition of human milk through multiple mechanisms. This review addresses the major topics of milk removal; chemosensory ecology for the parent-infant dyad; the infant's inputs into the composition of the human milk microbiome; and the impact of disruptions in gestation on the ecology of fetal and infant phenotypes, milk composition, and lactation. Milk removal, which is essential for adequate infant intake and continued milk synthesis through multiple hormonal and autocrine/paracrine mechanisms, should be effective, efficient, and comfortable for both the lactating parent and the infant. All 3 components should be included in the evaluation of milk removal. Breastmilk "bridges" flavor experiences in utero with postweaning foods, and the flavors become familiar and preferred. Infants can detect flavor changes in human milk resulting from parental lifestyle choices, including recreational drug use, and early experiences with the sensory properties of these recreational drugs impact subsequent behavioral responses. Interactions between the infant's own developing microbiome, that of the milk, and the multiple environmental factors that are drivers-both modifiable and nonmodifiable-in the microbial ecology of human milk are explored. Disruptions in gestation, especially preterm birth and fetal growth restriction or excess, impact the milk composition and lactation processes such as the timing of secretory activation, adequacy of milk volume and milk removal, and duration of lactation. Research gaps are identified in each of these areas. To assure a sustained and robust breastfeeding ecology, these myriad infant inputs must be systematically considered.
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Affiliation(s)
- Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | | | - Deborah L O'Connor
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah N Taylor
- Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Tita ATN, Carlo WA, McClure EM, Mwenechanya M, Chomba E, Hemingway-Foday JJ, Kavi A, Metgud MC, Goudar SS, Derman R, Lokangaka A, Tshefu A, Bauserman M, Bose C, Shivkumar P, Waikar M, Patel A, Hibberd PL, Nyongesa P, Esamai F, Ekhaguere OA, Bucher S, Jessani S, Tikmani SS, Saleem S, Goldenberg RL, Billah SM, Lennox R, Haque R, Petri W, Figueroa L, Mazariegos M, Krebs NF, Moore JL, Nolen TL, Koso-Thomas M. Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal Birth. N Engl J Med 2023; 388:1161-1170. [PMID: 36757318 PMCID: PMC10627427 DOI: 10.1056/nejmoa2212111] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 02/10/2023]
Abstract
BACKGROUND The use of azithromycin reduces maternal infection in women during unplanned cesarean delivery, but its effect on those with planned vaginal delivery is unknown. Data are needed on whether an intrapartum oral dose of azithromycin would reduce maternal and offspring sepsis or death. METHODS In this multicountry, placebo-controlled, randomized trial, we assigned women who were in labor at 28 weeks' gestation or more and who were planning a vaginal delivery to receive a single 2-g oral dose of azithromycin or placebo. The two primary outcomes were a composite of maternal sepsis or death and a composite of stillbirth or neonatal death or sepsis. During an interim analysis, the data and safety monitoring committee recommended stopping the trial for maternal benefit. RESULTS A total of 29,278 women underwent randomization. The incidence of maternal sepsis or death was lower in the azithromycin group than in the placebo group (1.6% vs. 2.4%), with a relative risk of 0.67 (95% confidence interval [CI], 0.56 to 0.79; P<0.001), but the incidence of stillbirth or neonatal death or sepsis was similar (10.5% vs. 10.3%), with a relative risk of 1.02 (95% CI, 0.95 to 1.09; P = 0.56). The difference in the maternal primary outcome appeared to be driven mainly by the incidence of sepsis (1.5% in the azithromycin group and 2.3% in the placebo group), with a relative risk of 0.65 (95% CI, 0.55 to 0.77); the incidence of death from any cause was 0.1% in the two groups (relative risk, 1.23; 95% CI, 0.51 to 2.97). Neonatal sepsis occurred in 9.8% and 9.6% of the infants, respectively (relative risk, 1.03; 95% CI, 0.96 to 1.10). The incidence of stillbirth was 0.4% in the two groups (relative risk, 1.06; 95% CI, 0.74 to 1.53); neonatal death within 4 weeks after birth occurred in 1.5% in both groups (relative risk, 1.03; 95% CI, 0.86 to 1.24). Azithromycin was not associated with a higher incidence in adverse events. CONCLUSIONS Among women planning a vaginal delivery, a single oral dose of azithromycin resulted in a significantly lower risk of maternal sepsis or death than placebo but had little effect on newborn sepsis or death. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; A-PLUS ClinicalTrials.gov number, NCT03871491.).
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Affiliation(s)
- Alan T N Tita
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Waldemar A Carlo
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Elizabeth M McClure
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Musaku Mwenechanya
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Elwyn Chomba
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Jennifer J Hemingway-Foday
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Avinash Kavi
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Mrityunjay C Metgud
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Shivaprasad S Goudar
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Richard Derman
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Adrien Lokangaka
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Antoinette Tshefu
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Melissa Bauserman
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Carl Bose
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Poonam Shivkumar
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Manju Waikar
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Archana Patel
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Patricia L Hibberd
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Paul Nyongesa
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Fabian Esamai
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Osayame A Ekhaguere
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Sherri Bucher
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Saleem Jessani
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Shiyam S Tikmani
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Sarah Saleem
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Robert L Goldenberg
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Sk M Billah
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Ruth Lennox
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Rashidul Haque
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - William Petri
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Lester Figueroa
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Manolo Mazariegos
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Nancy F Krebs
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Janet L Moore
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Tracy L Nolen
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
| | - Marion Koso-Thomas
- From the University of Alabama at Birmingham, Birmingham (A.T.N.T., W.A.C.); RTI International, Durham (E.M.M., J.J.H.-F., J.L.M., T.L.N.), and the University of North Carolina at Chapel Hill, Chapel Hill (M.B., C.B.) - both in North Carolina; University Teaching Hospital, Lusaka, Zambia (M. Mwenechanya, E.C.); Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi (A.K., M.C.M., S.S.G.), Mahatma Gandhi Institute of Medical Sciences, Sewagram (P.S.), Government Medical College (M.W.) and Lata Medical Research Foundation (A.P.), Nagpur, and Datta Meghe Institute of Medical Sciences, Wardha (A.P.) - all in India; Thomas Jefferson University, Philadelphia (R.D.); Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (A.L., A.T.); Boston University School of Public Health, Boston (P.L.H.); Moi University School of Medicine, Eldoret, Kenya (P.N., F.E.); Indiana School of Medicine, University of Indiana, Indianapolis (O.A.E., S.B.); Aga Khan University, Karachi, Pakistan (S.J., S.S.T., S.S.); Columbia University School of Medicine, New York (R.L.G.); the International Center for Diarrheal Disease Research, Dhaka (S.M.B., R.H.), and LAMB Hospital, Parbattipur (R.L.) - both in Bangladesh; the University of Sydney, Sydney (S.M.B.); the University of Virginia, Charlottesville (W.P.); Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala (L.F., M. Mazariegos); the University of Colorado-Anschutz Medical Campus, Denver (N.F.K.); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (M.K.-T.)
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Goldenberg RL, Saleem S, Billah SM, Kim J, Moore JL, Ghanchi NK, Haque R, Figueroa L, Ayala A, Lokangaka A, Tshefu A, Goudar SS, Kavi A, Somannavar M, Esamai F, Mwenechanya M, Chomba E, Patel A, Das P, Emonyi WI, Edidi S, Deshmukh M, Hossain B, Siraj S, Mazariegos M, Garces AL, Bauserman M, Bose CL, Petri WA, Krebs NF, Derman RJ, Carlo WA, Liechty EA, Hibberd PL, Koso‐Thomas M, Peres‐da‐Silva N, Nolen TL, McClure EM. COVID-19 antibody positivity over time and pregnancy outcomes in seven low-and-middle-income countries: A prospective, observational study of the Global Network for Women's and Children's Health Research. BJOG 2023; 130:366-376. [PMID: 36504437 PMCID: PMC9877904 DOI: 10.1111/1471-0528.17366] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine COVID-19 antibody positivity rates over time and relationships to pregnancy outcomes in low- and middle-income countries (LMICs). DESIGN With COVID-19 antibody positivity at delivery as the exposure, we performed a prospective, observational cohort study in seven LMICs during the early COVID-19 pandemic. SETTING The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR), a prospective, population-based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Bangladesh, Pakistan, India (two sites), and Guatemala. POPULATION Pregnant women enrolled in an ongoing pregnancy registry at study sites. METHODS From October 2020 to October 2021, standardised COVID-19 antibody testing was performed at delivery among women enrolled in MNHR. Trained staff masked to COVID-19 status obtained pregnancy outcomes, which were then compared with COVID-19 antibody results. MAIN OUTCOME MEASURES Antibody status, stillbirth, neonatal mortality, maternal mortality and morbidity. RESULTS At delivery, 26.0% of women were COVID-19 antibody positive. Positivity increased over the four time periods across all sites: 13.8%, 15.4%, 21.0% and 40.9%. In the final period, positivity rates were: DRC 27.0%, Kenya 33.1%, Pakistan 32.8%, Guatemala 37.0%, Zambia 37.8%, Bangladesh 47.2%, Nagpur, India 57.4% and Belagavi, India 62.4%. Adjusting for site and maternal characteristics, stillbirth, neonatal mortality, low birthweight and preterm birth were not significantly associated with COVID-19. The adjusted relative risk (aRR) for stillbirth was 1.27 (95% CI 0.95-1.69). Postpartum haemorrhage was associated with antibody positivity (aRR 1.44; 95% CI 1.01-2.07). CONCLUSIONS In pregnant populations in LMICs, COVID-19 antibody positivity has increased. However, most adverse pregnancy outcomes were not significantly associated with antibody positivity.
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Affiliation(s)
| | | | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research (icddr,b)DhakaBangladesh
- University of SydneySydneyNew South WalesAustralia
| | - Jean Kim
- RTI InternationalDurhamNorth CarolinaUSA
| | | | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research (icddr,b)DhakaBangladesh
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Alejandra Ayala
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Adrien Lokangaka
- Kinshasa School of Public HealthKinshasaDemocratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public HealthKinshasaDemocratic Republic of the Congo
| | - Shivaprasad S. Goudar
- KLE Academy Higher Education and Research, J N Medical College BelagaviKarnatakaIndia
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College BelagaviKarnatakaIndia
| | - Manjunath Somannavar
- KLE Academy Higher Education and Research, J N Medical College BelagaviKarnatakaIndia
| | | | | | - Elwyn Chomba
- University of Zambia University Teaching HospitalLusakaZambia
| | - Archana Patel
- Lata Medical Research FoundationNagpurIndia
- Datta Meghe Institute of Medical SciencesSawangiIndia
| | - Prabir Das
- Lata Medical Research FoundationNagpurIndia
| | | | - Samuel Edidi
- Laboratoire National de Référence du PNLSKinshasaDemocratic Republic of the Congo
| | | | - Biplob Hossain
- International Centre for Diarrhoeal Disease Research (icddr,b)DhakaBangladesh
| | - Shahjahan Siraj
- International Centre for Diarrhoeal Disease Research (icddr,b)DhakaBangladesh
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Ana L. Garces
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Melissa Bauserman
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Carl L. Bose
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Nancy F. Krebs
- University of Colorado School of MedicineDenverColoradoUSA
| | | | | | - Edward A. Liechty
- Indiana School of MedicineUniversity of IndianaIndianapolisIndianaUSA
| | | | - Marion Koso‐Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMarylandUSA
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Sherlock LG, Krebs NF. Small and Mighty: Micronutrients at the Intersection of Neonatal Immunity and Infection. Neoreviews 2023; 24:e158-e174. [PMID: 36854844 DOI: 10.1542/neo.24-3-e158] [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: 03/02/2023]
Abstract
Micronutrients are essential dietary components that regulate many biologic functions, including the immune response, and are required in small amounts (typically milligrams or less) in humans. Examples of micronutrients known to affect immune function include several trace minerals (such as zinc and selenium) as well as vitamins (including vitamins A and D). Deficiencies of specific micronutrients are associated with an increased risk of infection in infants in the NICU. Identifying micronutrient supplementation strategies during this period may result in low-cost interventions to reduce the burden of neonatal infectious disease. Many replacement trials thus far demonstrate conflicting results about whether micronutrient supplementation decreases the incidence or severity of sepsis in the neonatal period. The baseline incidence of micronutrient deficiency is important to consider but is often unknown as clinical assessment of micronutrient status occurs infrequently. Future research is needed to clarify the clinical scenarios in which optimizing micronutrient status in term and preterm infants may prevent infection or improve outcomes in those patients who become infected.
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Affiliation(s)
- Laura G Sherlock
- Perinatal Research Center, Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
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36
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Patterson JK, Neuwahl S, Goco N, Moore J, Goudar SS, Derman RJ, Hoffman M, Metgud M, Somannavar M, Kavi A, Okitawutshu J, Lokangaka A, Tshefu A, Bose CL, Mwapule A, Mwenechanya M, Chomba E, Carlo WA, Chicuy J, Figueroa L, Krebs NF, Jessani S, Saleem S, Goldenberg RL, Kurhe K, Das P, Patel A, Hibberd PL, Achieng E, Nyongesa P, Esamai F, Bucher S, Liechty EA, Bresnahan BW, Koso-Thomas M, McClure EM. Cost-effectiveness of low-dose aspirin for the prevention of preterm birth: a prospective study of the Global Network for Women's and Children's Health Research. Lancet Glob Health 2023; 11:e436-e444. [PMID: 36796987 DOI: 10.1016/s2214-109x(22)00548-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/28/2022] [Accepted: 12/15/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Premature birth is associated with an increased risk of mortality and morbidity, and strategies to prevent preterm birth are few in number and resource intensive. In 2020, the ASPIRIN trial showed the efficacy of low-dose aspirin (LDA) in nulliparous, singleton pregnancies for the prevention of preterm birth. We sought to investigate the cost-effectiveness of this therapy in low-income and middle-income countries. METHODS In this post-hoc, prospective, cost-effectiveness study, we constructed a probabilistic decision tree model to compare the benefits and costs of LDA treatment compared with standard care using primary data and published results from the ASPIRIN trial. In this analysis from a health-care sector perspective, we considered the costs and effects of LDA treatment, pregnancy outcomes, and neonatal health-care use. We did sensitivity analyses to understand the effect of the price of the LDA regimen, and the effectiveness of LDA in reducing both preterm birth and perinatal death. FINDINGS In model simulations, LDA was associated with 141 averted preterm births, 74 averted perinatal deaths, and 31 averted hospitalisations per 10 000 pregnancies. The reduction in hospitalisation resulted in a cost of US$248 per averted preterm birth, $471 per averted perinatal death, and $15·95 per disability-adjusted life year. INTERPRETATION LDA treatment in nulliparous, singleton pregnancies is a low-cost, effective treatment to reduce preterm birth and perinatal death. The low cost per disability-adjusted life year averted strengthens the evidence in support of prioritising the implementation of LDA in publicly funded health care in low-income and middle-income countries. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Affiliation(s)
- Jackie K Patterson
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Norman Goco
- RTI International, Research Triangle Park, NC, USA
| | - Janet Moore
- RTI International, Research Triangle Park, NC, USA
| | | | - Richard J Derman
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Hoffman
- Department of Obstetrics and Gynecology, Christiana Care, Newark, DE, USA
| | | | | | - Avinash Kavi
- Jawaharlal Nehru Medical College, KLE University, Belagavi, India
| | - Jean Okitawutshu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Carl L Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Javier Chicuy
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | - Lester Figueroa
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Saleem Jessani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur & Datta Meghe Institute of Medical Sciences, Sawangi, India
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur & Datta Meghe Institute of Medical Sciences, Sawangi, India
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur & Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | - Emmah Achieng
- Department of Child Health and Paediatrics, School of Medicine, Moi University, Eldoret, Kenya
| | - Paul Nyongesa
- Department of Child Health and Paediatrics, School of Medicine, Moi University, Eldoret, Kenya
| | - Fabian Esamai
- Department of Child Health and Paediatrics, School of Medicine, Moi University, Eldoret, Kenya
| | - Sherri Bucher
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Oberlin A, Wallace J, Moore JL, Saleem S, Lokangaka A, Tshefu A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Liechty E, Bucher S, Patel AB, Hibberd PL, Chomba E, Carlo WA, Goudar S, Derman RJ, Koso-Thomas M, McClure EM, Goldenberg RL. Examining maternal morbidity across a spectrum of delivery locations: An analysis of the Global Network's Maternal and Neonatal Health Registry. Int J Gynaecol Obstet 2023; 160:797-805. [PMID: 35949060 PMCID: PMC9911556 DOI: 10.1002/ijgo.14391] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To better understand maternal morbidity, using quality data from low- and middle-income countries (LMICs), including out-of-hospital deliveries. Additionally, to compare to the WHO estimate that maternal morbidity occurs in 15% of pregnancies, which is based largely on hospital-level data. METHODS The Global Network for Women's and Children's Health Research Maternal Newborn Health Registry collected data on all pregnancies from seven sites in six LMICs between 2015 and 2020. Rates of maternal mortality and morbidity and the differences in morbidity across delivery location and birth attendant type were evaluated. RESULTS Among the 280 584 deliveries included in the present analysis, the overall maternal mortality ratio was 138 per 100 000, while 11.7% of women experienced at least one morbidity. Rates of morbidity were generally higher for deliveries occurring within hospitals (19.8%) and by physicians (23.6%). The lowest rates of morbidity were noted among women delivering in non-hospital healthcare facilities (5.6%) or with non-physician clinicians (e.g. nurses, midwives [5.4%]). CONCLUSION The present study shows important differences in reported maternal morbidity across delivery sites, with a trend towards lower morbidity in non-hospital healthcare facilities and among non-physician clinicians.
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Affiliation(s)
- Austin Oberlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Jacqueline Wallace
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Janet L. Moore
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | - Edward Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Sheri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Archana B. Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | | | - Shivaprasad Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Elizabeth M. McClure
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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Tang M, Ma C, Weinheimer-Haus EM, Robertson CE, Kofonow JM, Berman LM, Waljee A, Zhu J, Frank DN, Krebs NF. Different gut microbiota in U.S. formula-fed infants consuming a meat vs. dairy-based complementary foods: A randomized controlled trial. Front Nutr 2023; 9:1063518. [PMID: 36778973 PMCID: PMC9909089 DOI: 10.3389/fnut.2022.1063518] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 01/27/2023] Open
Abstract
Objective This project aimed to evaluate the impact of meat- vs. dairy-based complementary foods on gut microbiota and whether it relates to growth. Design Full-term, formula-fed infants were recruited from the metro Denver area (Colorado, US) and randomized to a meat- or dairy-based complementary diet from 5 to 12 months of age. Infant's length and weight were measured, and stool samples were collected at 5, 10, and 12 months for 16S rRNA gene sequencing and short-chain fatty acids (SCFAs) quantification. Results Sixty-four infants completed the dietary intervention (n = 32/group). Weight-for-age Z (WAZ) scores increased in both groups and length-for-age Z scores (LAZ) increased in the meat group only, which led to a significant group-by-time interaction (P = 0.02) of weight-for-length Z (WLZ) score. Microbiota composition (Beta-diversity) differed between groups at 12 months (weighted PERMANOVA P = 0.01) and had a group-by-time interaction of P = 0.09. Microbial community richness (Chao1) increased in the meat group only. Genus Akkermansia had a significant group-by-time interaction and increased in the dairy group and decreased in the meat group. A significant fold change of butyric acid from 5 to 12 months was found in the meat group (+1.75, P = 0.011) but not in the dairy group. Regression analysis showed that Chao1 had a negative association with WLZ and WAZ. Several genera also had significant associations with all growth Z scores. Conclusion Complementary feeding not only impacts infant growth but also affects gut microbiota maturation. Complementary food choices can affect both the gut microbiota diversity and structures and these changes in gut microbiota are associated with infant growth.
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Affiliation(s)
- Minghua Tang
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Cheng Ma
- Department of Statistics, University of Michigan, Ann Arbor, MI, United States
| | - Eileen M. Weinheimer-Haus
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States
| | - Charles E. Robertson
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer M. Kofonow
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lillian M. Berman
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Akbar Waljee
- Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Ji Zhu
- Department of Statistics, University of Michigan, Ann Arbor, MI, United States
| | - Daniel N. Frank
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nancy F. Krebs
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Hoffman M, Dhaded S, Figueroa L, Mazariegos M, Krebs NF, Sunder S, Karim F, Lokangaka A, Buserman M, Patel A, Hibberd P, Das P, Tshefu A, Chomba E, Mwencheanya M, Carlo W, Trotta M, Williams-Jones A, Moore J, Nolen T, McClure E, Lobo M, Cunha A, Derman R. Neurodevelopmental outcomes of children whose mothers were randomized to low-dose aspirin in early pregnancy. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Shankar K, Ali SA, Ruebel ML, Jessani S, Borengasser SJ, Gilley SP, Jambal P, Yazza DN, Weaver N, Kemp JF, Westcott JL, Hendricks AE, Saleem S, Goldenberg RL, Hambidge KM, Krebs NF. Maternal nutritional status modifies heat-associated growth restriction in women with chronic malnutrition. PNAS Nexus 2023; 2:pgac309. [PMID: 36744021 PMCID: PMC9896899 DOI: 10.1093/pnasnexus/pgac309] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
Rapid changes in the global climate are deepening existing health disparities from resource scarcity and malnutrition. Rising ambient temperatures represent an imminent risk to pregnant women and infants. Both maternal malnutrition and heat stress during pregnancy contribute to poor fetal growth, the leading cause of diminished child development in low-resource settings. However, studies explicitly examining interactions between these two important environmental factors are lacking. We leveraged maternal and neonatal anthropometry data from a randomized controlled trial focused on improving preconception maternal nutrition (Women First Preconception Nutrition trial) conducted in Thatta, Pakistan, where both nutritional deficits and heat stress are prevalent. Multiple linear regression of ambient temperature and neonatal anthropometry at birth (n = 459) showed a negative association between daily maximal temperatures in the first trimester and Z-scores of birth length and head circumference. Placental mRNA-sequencing and protein analysis showed transcriptomic changes in protein translation, ribosomal proteins, and mTORC1 signaling components in term placenta exposed to excessive heat in the first trimester. Targeted metabolomic analysis indicated ambient temperature associated alterations in maternal circulation with decreases in choline concentrations. Notably, negative impacts of heat on birth length were in part mitigated in women randomized to comprehensive maternal nutritional supplementation before pregnancy suggesting potential interactions between heat stress and nutritional status of the mother. Collectively, the findings bridge critical gaps in our current understanding of how maternal nutrition may provide resilience against adverse effects of heat stress in pregnancy.
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Affiliation(s)
- Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Meghan L Ruebel
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
- USDA-ARS, Southeast Area, Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA
| | | | - Sarah J Borengasser
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Stephanie P Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Puujee Jambal
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Deaunabah N Yazza
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nicholas Weaver
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, CO 80204, USA
| | - Jennifer F Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Jamie L Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Audrey E Hendricks
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, CO 80204, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Naila NN, Das S, Mim Khandaker A, Alam R, Westcott J, Long J, Krebs NF, Islam MM, Ahmed T. Improving Calcium Status of Women: Results of a Study of Bio-Availability of Calcium From Slaked Lime Fortified Rice. Food Nutr Bull 2022; 43:429-438. [PMID: 36168746 DOI: 10.1177/03795721221117624] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fortification of rice with slaked lime is an acceptable and inexpensive way to combat calcium (Ca) deficiency. However, bioavailability of calcium after intake of slaked lime fortified rice is yet to be investigated. OBJECTIVE To measure the fractional absorption of Ca (FAC) from slaked lime fortified cooked rice. DESIGN We conducted an experimental study using stable isotopes of Ca to measure FAC during a single morning test meal containing rice fortified with slaked lime. Participants (n = 22) were given slaked lime fortified rice 3 times a day for 4 days. On the morning of the fifth day, the participants were served the same amount of rice as previous the 4 days at the breakfast test meal with an accurately measured amount of 44Ca stable isotope oral tracer followed by an intravenous injection of 42Ca. Urine was collected over the next 24 hours in 3 consecutive 8-hour pools. Fractional absorption of Ca was calculated from the measurement of the relative enrichment of the of each administered tracer 44Ca and 42Ca using inductively coupled plasma mass spectrometry. RESULTS The mean Ca concentration in the test meal was 879.5 ± 152.9 µg/g with a coefficient of variance (CV) of 17.2%. Although Ca absorption efficiency decreases with higher calcium intake, the total amount of calcium absorbed from test meal using FAC = 0.391 calculated from the third 8-hour urine pool was 69.0 (CV of 15.6) mg. CONCLUSIONS We showed that one-fifth of daily calcium recommendation for women of reproductive age could be met by ingesting ∼200 g cooked slake fortified rice.
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Affiliation(s)
- Nurun Nahar Naila
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Subhasish Das
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | | | - Rahvia Alam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Jamie Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie Long
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - M Munirul Islam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.,Department of Global Health, University of Washington, Seattle, WA, USA.,James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
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Naqvi S, Saleem S, Naqvi F, Billah SM, Nielsen E, Fogleman E, Peres‐da‐Silva N, Figueroa L, Mazariegos M, Garces AL, Patel A, Das P, Kavi A, Goudar SS, Esamai F, Chomba E, Lokangaka A, Tshefu A, Haque R, Siraj S, Yousaf S, Bauserman M, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Petri WA, Hibberd PL, Koso‐Thomas M, Thorsten V, McClure EM, Goldenberg RL. Knowledge, attitudes, and practices of pregnant women regarding COVID-19 vaccination in pregnancy in 7 low- and middle-income countries: An observational trial from the Global Network for Women and Children's Health Research. BJOG 2022; 129:2002-2009. [PMID: 35596701 PMCID: PMC9347929 DOI: 10.1111/1471-0528.17226] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/11/2022] [Accepted: 05/15/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We sought to determine the knowledge, attitudes and practices of pregnant women regarding COVID-19 vaccination in pregnancy in seven low- and middle-income countries (LMIC). DESIGN Prospective, observational, population-based study. SETTINGS Study areas in seven LMICs: Bangladesh, India, Pakistan, Guatemala, Democratic Republic of the Congo (DRC), Kenya and Zambia. POPULATION Pregnant women in an ongoing registry. METHODS COVID-19 vaccine questionnaires were administered to pregnant women in the Global Network's Maternal Newborn Health Registry from February 2021 through November 2021 in face-to-face interviews. MAIN OUTCOME MEASURES Knowledge, attitude and practice regarding vaccination during pregnancy; vaccination status. RESULTS No women were vaccinated except for small proportions in India (12.9%) and Guatemala (5.5%). Overall, nearly half the women believed the COVID-19 vaccine is very/somewhat effective and a similar proportion believed that the COVID-19 vaccine is safe for pregnant women. With availability of vaccines, about 56.7% said they would get the vaccine and a 34.8% would refuse. Of those who would not get vaccinated, safety, fear of adverse effects, and lack of trust predicted vaccine refusal. Those with lower educational status were less willing to be vaccinated. Family members and health professionals were the most trusted source of information for vaccination. CONCLUSIONS This COVID-19 vaccine survey in seven LMICs found that knowledge about the effectiveness and safety of the vaccine was generally low but varied. Concerns about vaccine safety and effectiveness among pregnant women is an important target for educational efforts to increase vaccination rates.
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Affiliation(s)
| | | | | | - Sk Masum Billah
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
- University of VirginiaCharlottesvilleVirginiaUSA
| | | | | | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | - Ana L. Garces
- Instituto de Nutrición de Centroamérica y PanamáGuatemala CityGuatemala
| | | | - Prabir Das
- Lata Medical Research FoundationNagpurIndia
| | - Avinash Kavi
- KLE Academy Higher Education and ResearchJ N Medical CollegeBelagaviIndia
| | | | | | | | - Adrien Lokangaka
- Department of PediatricsKinshasa School of Public HealthKinshasaDemocratic Republic of the Congo
| | - Antoinette Tshefu
- Department of PediatricsKinshasa School of Public HealthKinshasaDemocratic Republic of the Congo
| | - Rashidul Haque
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Shahjahan Siraj
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | | | - Melissa Bauserman
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Edward A. Liechty
- Department of PediatricsIndiana School of Medicine, University of IndianaIndianapolisIndianaUSA
| | - Nancy F. Krebs
- Section of Nutrition, Department of PediatricsUniversity of Colorado School of MedicineDenverColoradoUSA
| | | | | | | | | | - Marion Koso‐Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaMarylandUSA
| | | | | | - Robert L. Goldenberg
- Department of Obstetrics and GynecologyColumbia University School of MedicineNew YorkNew YorkUSA
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McDonald CM, Black RE, Krebs NF, Islam MM. Reply to R Pullakhandam et al. J Nutr 2022; 152:2310-2311. [PMID: 35939363 DOI: 10.1093/jn/nxac156] [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: 11/14/2022] Open
Affiliation(s)
| | - Robert E Black
- International Zinc Nutrition Consultative Group, San Francisco, CA, USA
| | - Nancy F Krebs
- International Zinc Nutrition Consultative Group, San Francisco, CA, USA
| | - Munir M Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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Arriaza A, Hambidge KM, Krebs NF, Garcés A, Channon AA. The trend in mean height of Guatemalan women born between 1945 and 1995: a century behind. J Health Popul Nutr 2022; 41:43. [PMID: 36109796 PMCID: PMC9476692 DOI: 10.1186/s41043-022-00324-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/07/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Adult height is a cumulative indicator of living standards with mean height increasing with a greater socio-economic level. Guatemalan adult women have the lowest mean height worldwide. The country's population is ethnically divided between indigenous and non-indigenous groups. This study aims to identify trends in the mean height for indigenous and non-indigenous adult women born between 1945 and 1995 in Guatemala and the association with individual, household and environmental factors. METHODS We used pooled data of adult women from five Demographic and Health Surveys. Mixed-effects multilevel linear regression models estimate the mean height associated with the explanatory variables. Mean height was modelled as a function of birth year cohort, wealth, education, geo-administrative regions and elevation. RESULTS The mean height increased 0.021 cm per year on average. The annual increase for indigenous women was 0.027 cm, while 0.017 cm for non-indigenous women. Height is associated with household wealth and women's education level. We found an interaction effect between ethnicity and household wealth, with indigenous women at the lowest quintile 0.867 cm shorter than the corresponding non-indigenous group. Height is associated with the geo-administrative region, those women in western regions being shorter than those in the metropolis. Mean height is reduced 0.980 cm for each 1000 m increase in elevation. CONCLUSIONS Guatemalan women have grown only 1 cm over half century, a slow improvement between 1945 and 1995, a period characterised by political instability and civil war. There are persistent inequalities in women's height associated with socio-economic status, education and attributes of the geographical context. These aspects need to be considered when implementing strategies to encourage growth. Further research is required to understand the evolution of adult height and the standard of living in post-war Guatemala.
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Affiliation(s)
- Astrid Arriaza
- Institute of Nutrition of Central America and Panama, Calzada Roosevelt, 6-25, Zona 11, Guatemala City, 01011 Guatemala
| | - K. Michael Hambidge
- University of Colorado School of Medicine, 12700 East 19th Avenue, Box C225, Aurora, CO 80045 USA
| | - Nancy F. Krebs
- University of Colorado School of Medicine, 12700 East 19th Avenue, Box C225, Aurora, CO 80045 USA
| | - Ana Garcés
- Institute of Nutrition of Central America and Panama, Calzada Roosevelt, 6-25, Zona 11, Guatemala City, 01011 Guatemala
| | - Andrew Amos Channon
- Centre for Global Health and Policy, University of Southampton, Southampton, UK
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McDonald CM, Brown KH, Goh YE, Manger MS, Arnold CD, Krebs NF, Westcott J, Long JM, Gibson RS, Jamwal M, Singh BL, Dahiya N, Budhija D, Das R, Duggal M. Quintuply-fortified salt for the improvement of micronutrient status among women of reproductive age and preschool-aged children in Punjab, India: protocol for a randomized, controlled, community-based trial. BMC Nutr 2022; 8:98. [PMID: 36068647 PMCID: PMC9450288 DOI: 10.1186/s40795-022-00583-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Multiple micronutrient (MN) deficiencies remain highly prevalent among women of reproductive age (WRA) and preschool-aged children (PSC) in many areas within India. Salt is an attractive vehicle for MN fortification in this context, as it is universally consumed in fairly consistent amounts and coverage of iodized salt (IS) is 94%. The overall objective of this trial is to evaluate the nutritional impact of quintuply-fortified salt with iron in the form of encapsulated ferrous fumarate, zinc, vitamin B12, folic acid, and iodine (eFF-Q5S) vs. quintuply-fortified salt with iron in the form of ferric pyrophosphate plus EDTA, zinc, vitamin B12, folic acid, and iodine (FePP-Q5S) vs. IS for the improvement of MN status among non-pregnant WRA and PSC. Methods The study is a community-based, randomized, controlled trial that will be conducted in Punjab, India. 780 non-pregnant WRA 18–49 years old and 468 PSC 12–59 months old will be enrolled and assigned to one of three intervention groups. Salt will be provided to participants monthly for 12 months. Primary outcomes include changes in mean concentration of biomarkers of iron, zinc, vitamin B12, folate and iodine. Secondary outcomes include changes in the composition of the gut microbiome, and discretionary salt intake of PSC. Discussion If proven efficacious, multiply-fortified salt (MFS) has the potential to drastically reduce the burden of MN deficiencies in India, and around the world. Although effectiveness research will be needed to examine the impact of MFS under programmatic conditions, salt fortification will piggy-back on existing platforms to produce IS and doubly-fortified salt (DFS), making it possible to scale-up the intervention quickly. Trial registration Clinicaltrials.gov: NCT05166980; date of registration: December 22, 2021. Clinical Trials Registry-India: CTRI/2022/040332 and CTRI/2022/02/040333; date of registration: February 15, 2022.
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Affiliation(s)
- Christine M McDonald
- Departments of Pediatrics, and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. .,Department of Nutrition, and Institute for Global Nutrition, University of California, Davis, CA, USA. .,International Zinc Nutrition Consultative Group, Oakland, CA, USA.
| | - Kenneth H Brown
- Department of Nutrition, and Institute for Global Nutrition, University of California, Davis, CA, USA.,International Zinc Nutrition Consultative Group, Oakland, CA, USA
| | - Yvonne E Goh
- Departments of Pediatrics, and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,International Zinc Nutrition Consultative Group, Oakland, CA, USA
| | - Mari S Manger
- Departments of Pediatrics, and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,International Zinc Nutrition Consultative Group, Oakland, CA, USA
| | - Charles D Arnold
- Department of Nutrition, and Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Nancy F Krebs
- International Zinc Nutrition Consultative Group, Oakland, CA, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Jamie Westcott
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie M Long
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Manu Jamwal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bidhi L Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Dahiya
- Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Indian Council of Medical Research, Delhi, India
| | - Deepmala Budhija
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mona Duggal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Patel AB, Bann CM, Kolhe CS, Lokangaka A, Tshefu A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Bucher S, Saleem S, Goldenberg RL, Chomba E, Carlo WA, Goudar S, Derman RJ, Koso-Thomas M, McClure EM, Hibberd PL. The Global Network Socioeconomic Status Index as a predictor of stillbirths, perinatal mortality, and neonatal mortality in rural communities in low and lower middle income country sites of the Global Network for Women's and Children's Health Research. PLoS One 2022; 17:e0272712. [PMID: 35972913 PMCID: PMC9380930 DOI: 10.1371/journal.pone.0272712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Globally, socioeconomic status (SES) is an important health determinant across a range of health conditions and diseases. However, measuring SES within low- and middle-income countries (LMICs) can be particularly challenging given the variation and diversity of LMIC populations. OBJECTIVE The current study investigates whether maternal SES as assessed by the newly developed Global Network-SES Index is associated with pregnancy outcomes (stillbirths, perinatal mortality, and neonatal mortality) in six LMICs: Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan, and Zambia. METHODS The analysis included data from 87,923 women enrolled in the Maternal and Newborn Health Registry of the NICHD-funded Global Network for Women's and Children's Health Research. Generalized estimating equations models were computed for each outcome by SES level (high, moderate, or low) and controlling for site, maternal age, parity, years of schooling, body mass index, and facility birth, including sampling cluster as a random effect. RESULTS Women with low SES had significantly higher risks for stillbirth (p < 0.001), perinatal mortality (p = 0.001), and neonatal mortality (p = 0.005) than women with high SES. In addition, those with moderate SES had significantly higher risks of stillbirth (p = 0.003) and perinatal mortality (p = 0.008) in comparison to those with high SES. CONCLUSION The SES categories were associated with pregnancy outcomes, supporting the validity of the index as a non-income-based measure of SES for use in studies of pregnancy outcomes in LMICs.
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Affiliation(s)
- Archana B. Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Carla M. Bann
- RTI International, Research Triangle Park, NC, United States of America
| | | | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO, United States of America
| | | | - Sherri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, United States of America
| | | | | | | | - Waldemar A. Carlo
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Shivaprasad Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | - Richard J. Derman
- Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | | | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
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Tang M, Weaver NE, Frank DN, Ir D, Robertson CE, Kemp JF, Westcott J, Shankar K, Garces AL, Figueroa L, Tshefu AK, Lokangaka AL, Goudar SS, Somannavar M, Aziz S, Saleem S, McClure EM, Hambidge KM, Hendricks AE, Krebs NF. Longitudinal Reduction in Diversity of Maternal Gut Microbiota During Pregnancy Is Observed in Multiple Low-Resource Settings: Results From the Women First Trial. Front Microbiol 2022; 13:823757. [PMID: 35979501 PMCID: PMC9376441 DOI: 10.3389/fmicb.2022.823757] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To characterize the changes in gut microbiota during pregnancy and determine the effects of nutritional intervention on gut microbiota in women from sub-Saharan Africa (the Democratic Republic of the Congo, DRC), South Asia (India and Pakistan), and Central America (Guatemala). Methods Pregnant women in the Women First (WF) Preconception Maternal Nutrition Trial were included in this analysis. Participants were randomized to receive a lipid-based micronutrient supplement either ≥3 months before pregnancy (Arm 1); started the same intervention late in the first trimester (Arm 2); or received no nutrition supplements besides those self-administered or prescribed through local health services (Arm 3). Stool and blood samples were collected during the first and third trimesters. Findings presented here include fecal 16S rRNA gene-based profiling and systemic and intestinal inflammatory biomarkers, including alpha (1)-acid glycoprotein (AGP), C-reactive protein (CRP), fecal myeloperoxidase (MPO), and calprotectin. Results Stool samples were collected from 640 women (DRC, n = 157; India, n = 102; Guatemala, n = 276; and Pakistan, n = 105). Gut microbial community structure did not differ by intervention arm but changed significantly during pregnancy. Richness, a measure of alpha-diversity, decreased over pregnancy. Community composition (beta-diversity) also showed a significant change from first to third trimester in all four sites. Of the top 10 most abundant genera, unclassified Lachnospiraceae significantly decreased in Guatemala and unclassified Ruminococcaceae significantly decreased in Guatemala and DRC. The change in the overall community structure at the genus level was associated with a decrease in the abundances of certain genera with low heterogeneity among the four sites. Intervention arms were not significantly associated with inflammatory biomarkers at 12 or 34 weeks. AGP significantly decreased from 12 to 34 weeks of pregnancy, whereas CRP, MPO, and calprotectin did not significantly change over time. None of these biomarkers were significantly associated with the gut microbiota diversity. Conclusion The longitudinal reduction of individual genera (both commensals and potential pathogens) and alpha-diversity among all sites were consistent and suggested that the effect of pregnancy on the maternal microbiota overrides other influencing factors, such as nutrition intervention, geographical location, diet, race, and other demographical variables.
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Affiliation(s)
- Minghua Tang
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nicholas E. Weaver
- Department of Mathematical and Statistical Sciences, University of Colorado, Denver, Denver, CO, United States
| | - Daniel N. Frank
- Department of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Diana Ir
- Department of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Charles E. Robertson
- Department of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer F. Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jamie Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ana L. Garces
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Lester Figueroa
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Antoinette K. Tshefu
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Adrien L. Lokangaka
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Shivaprasad S. Goudar
- KLE Academy of Higher Education and Research (Deemed-to-be-University), Jawaharlal Nehru Medical College, Belagavi, India
| | - Manjunath Somannavar
- KLE Academy of Higher Education and Research (Deemed-to-be-University), Jawaharlal Nehru Medical College, Belagavi, India
| | - Sumera Aziz
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - K. Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Audrey E. Hendricks
- Department of Mathematical and Statistical Sciences, University of Colorado, Denver, Denver, CO, United States
| | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Krebs NF, Hambidge KM, Westcott JL, Garcés AL, Figueroa L, Tshefu AK, Lokangaka AL, Goudar SS, Dhaded SM, Saleem S, Ali SA, Bauserman MS, Derman RJ, Goldenberg RL, Das A, Chowdhury D. Birth length is the strongest predictor of linear growth status and stunting in the first 2 years of life after a preconception maternal nutrition intervention: the children of the Women First trial. Am J Clin Nutr 2022; 116:86-96. [PMID: 35681255 PMCID: PMC9257468 DOI: 10.1093/ajcn/nqac051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/16/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The multicountry Women First trial demonstrated that nutritional supplementation initiated prior to conception (arm 1) or early pregnancy (arm 2) and continued until delivery resulted in significantly greater length at birth and 6 mo compared with infants in the control arm (arm 3). OBJECTIVES We evaluated intervention effects on infants' longitudinal growth trajectory from birth through 24 mo and identified predictors of length status and stunting at 24 mo. METHODS Infants' anthropometry was obtained at 6, 12, 18, and 24 mo after the Women First trial (registered at clinicaltrials.gov as NCT01883193), which was conducted in low-resource settings: Democratic Republic of Congo, Guatemala, India, and Pakistan. Longitudinal models evaluated intervention effects on infants' growth trajectory from birth to 24 mo, with additional modeling used to identify adjusted predictors for growth trajectories and outcomes at 24 mo. RESULTS Data for 2337 (95% of original live births) infants were evaluated. At 24 mo, stunting rates were 62.8%, 64.8%, and 66.3% for arms 1, 2, and 3, respectively (NS). For the length-for-age z-score (LAZ) trajectory, treatment arm was a significant predictor, with adjusted mean differences of 0.19 SD (95% CI: 0.08, 0.30; P < 0.001) and 0.17 SD (95% CI: 0.07, 0.27; P < 0.001) for arms 1 and 2, respectively. The strongest predictors of LAZ at 24 mo were birth LAZ <-2 and <-1 to ≥-2, with adjusted mean differences of -0.76 SD (95% CI: -0.93, -0.58; P < 0.001) and -0.47 SD (95% CI: -0.56, -0.38; P < 0.001), respectively. For infants with ultrasound-determined gestational age (n = 1329), the strongest predictors of stunting were birth LAZ <-2 and <-1 to ≥- 2: adjusted relative risk of 1.62 (95% CI: 1.39, 1.88; P < 0.001) and 1.46 (95% CI: 1.31, 1.62; P < 0.001), respectively. CONCLUSIONS Substantial improvements in postnatal growth are likely to depend on improved intrauterine growth, especially during early pregnancy.
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Affiliation(s)
- Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Denver, CO, USA
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Denver, CO, USA
| | - Jamie L Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Denver, CO, USA
| | - Ana L Garcés
- Unidad de Salud Materno Infantil, Instituto de Nutrición de Centroamérica y Panamá (INCAP), Calzada Roosevelt, Guatemala City, Guatemala
| | - Lester Figueroa
- Unidad de Salud Materno Infantil, Instituto de Nutrición de Centroamérica y Panamá (INCAP), Calzada Roosevelt, Guatemala City, Guatemala
| | - Antoinette K Tshefu
- Kinshasa School of Public Health, Hôpital Général de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Adrien L Lokangaka
- Kinshasa School of Public Health, Hôpital Général de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sumera Aziz Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Melissa S Bauserman
- Department of Pediatrics Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Richard J Derman
- Department of OBGYN, Thomas Jefferson University, Philadelphia, PA, USA
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Affiliation(s)
- Susan L Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Stephanie P Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
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50
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Naqvi S, Naqvi F, Saleem S, Thorsten VR, Figueroa L, Mazariegos M, Garces A, Patel A, Das P, Kavi A, Goudar SS, Esamai F, Mwenchanya M, Chomba E, Lokangaka A, Tshefu A, Yousuf S, Bauserman M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Hibberd PL, Billah SM, Peres-da-Silva N, Haque R, Petri WA, Koso-Thomas M, Nolen T, McClure EM, Goldenberg RL. Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six low- and-middle-income countries: Evidence from a prospective, observational registry of the Global Network for Women's and Children's Health. BJOG 2022; 129:1298-1307. [PMID: 35377514 PMCID: PMC9111322 DOI: 10.1111/1471-0528.17175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/19/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
Objective To assess, on a population basis, the medical care for pregnant women in specific geographic regions of six countries before and during the first year of the coronavirus disease 2019 (COVID‐19) pandemic in relationship to pregnancy outcomes. Design Prospective, population‐based study. Setting Communities in Kenya, Zambia, the Democratic Republic of the Congo, Pakistan, India and Guatemala. Population Pregnant women enrolled in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry. Methods Pregnancy/delivery care services and pregnancy outcomes in the pre‐COVID‐19 time‐period (March 2019–February 2020) were compared with the COVID‐19 time‐period (March 2020–February 2021). Main outcome measures Stillbirth, neonatal mortality, preterm birth, low birthweight and maternal mortality. Results Across all sites, a small but statistically significant increase in home births occurred between the pre‐COVID‐19 and COVID‐19 periods (18.9% versus 20.3%, adjusted relative risk [aRR] 1.12, 95% CI 1.05–1.19). A small but significant decrease in the mean number of antenatal care visits (from 4.1 to 4.0, p = <0.0001) was seen during the COVID‐19 period. Of outcomes evaluated, overall, a small but significant decrease in low‐birthweight infants in the COVID‐19 period occurred (15.7% versus 14.6%, aRR 0.94, 95% CI 0.89–0.99), but we did not observe any significant differences in other outcomes. There was no change observed in maternal mortality or antenatal haemorrhage overall or at any of the sites. Conclusions Small but significant increases in home births and decreases in the antenatal care services were observed during the initial COVID‐19 period; however, there was not an increase in the stillbirth, neonatal mortality, maternal mortality, low birthweight, or preterm birth rates during the COVID‐19 period compared with the previous year. Further research should help to elucidate the relationship between access to and use of pregnancy‐related medical services and birth outcomes over an extended period.
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Affiliation(s)
| | | | | | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Manolo Mazariegos
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Ana Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India.,Datta Meghe Institute of Medical, Sciences, Sawangi, India
| | - Prabir Das
- Lata Medical Research Foundation, Nagpur, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India
| | | | | | - Elwyn Chomba
- University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
| | | | | | | | - Sk Masum Billah
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,University of Sydney, Sydney, New South Wales, Australia
| | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Tracy Nolen
- RTI International, Durham, North Carolina, USA
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