Calcium Consumption During Pregnancy: A Multicenter Study in a Middle-Income Country in Southeast Asia

Objective

To perform a cross-sectional observational study of calcium consumption among pregnant women from multicenter tertiary care hospitals in the middle-income country in Southeast Asia.

Study Design

A cross-sectional observational study.

Setting

The study was conducted in four geographical regions (northern, northeastern, southern, and central) of Thailand. Five participating hospitals consisted of one university hospital in each region and one additional tertiary care hospital in the central region.

Materials and Methods

A cross-sectional study was performed nationwide from 1st November 2017 to 31st January 2019. All singleton aged 19-40 years were included. Exclusion criteria were any conditions that influenced calcium-containing food consumption. Dietary intake self-records immediately after eating for two working days and one holiday were analyzed via INMUCAL-NV3.0 dietary program.

Results

The 1549 records were obtained. The mean age was 29 ± 5.7 years. Most participants were primigravida (48.6%). The average gestational age was 20.6 ± 8.8 weeks. Mean calcium consumption was 602.4 mg/day (95% CI; 589.2615.6 mg/day) mg/dL. Inadequate calcium consumption prevalence based on the Thai dietary reference intake (less than 800 mg/day) and US Institute of Medicine (less than 1000 mg/day) were 82.0% and 93.4%, respectively.

Conclusion

The mean calcium consumption among pregnant women in the middle-income country in Southeast Asia was 602.4 mg/day (95% CI 589.2-615.6 mg/day). Inadequate calcium consumption of Thai pregnant women prevalence was 82.0% and 93.4% according to Thai dietary reference intake in pregnancy and the US Institute of Medicine.

Analyzing pregnancy outcomes in women of extremely advanced maternal age (> or = 45 years)

OBJECTIVE

To assesses pregnancy outcomes in women of extremely advanced maternal age (> or = 45 years).

MATERIAL AND METHOD

Computerized delivery records, collected between January 2002 and December 2012 at Rajavithi Hospital, were retrospectively reviewed We compared the condition of women of maternal age > or = 45 years with singleton delivery and beyond 24 weeks of gestation (n = 82) in a 1:4 ratio with those women age 20 to 29 years (n = 328).

RESULTS

Extremely advanced maternal age was significantly associated with a higher incidence of gestational diabetes mellitus (OR = 5.33; CI = 1.90-14.95), preeclampsia (OR = 4; CI = 1.99-8.06), preterm birth (OR = 1.74; 95% CI = 1.15-2.62), cesarean delivery (OR = 4.18; 95% CI = 2.52-6.93), postpartum hemorrhage (OR = 6.5; CI = 2.79-15.16), blood transfusion (3.7% vs. 0%; p = 0.008), placenta previa (OR = 16; 95% CI = 1.18-141.25), low birth weight (OR = 2.77; 95% CI = 1.23-6.25), very low birth weight (OR = 3.00; 95% CI = 1.07-8.4), low Apgar scores at 5 minutes (OR = 2.77; 95% CI 1.23-6.25), and perinatal death (OR = 6.00; 95% CI = 1.73-20.77).

CONCLUSION

Women aged 45 or more experienced increased maternal and neonatal adverse outcomes when compared with younger women. Women in an extreme age group are advised that although they might face a significantly increased risk of complications, most of them could have successful outcomes. An extremely advanced age is not contradicted for pregnancy. Obstetricians must be especially careful when taking care of extremely advanced age pregnancy.

Effectiveness of the model for prenatal control of severe thalassemia

OBJECTIVE

The aim of the research was to determine effectiveness of the model for prenatal control in reducing new cases of severe thalassemia.

METHODS

Pregnant women at six tertiary centers were recruited to follow the model, consisting of (1) carrier screening using mean corpuscular volume (for alpha-thal-1 and beta-thal) and CMU-E screen (for HbE trait), (2) carrier diagnosis, (3) the couples at risk were counseled and offered prenatal diagnosis, and (4) termination of affected pregnancy. All neonates were evaluated for thalassemia.

RESULTS

Of the 12,874 recruited pregnancies, 7008 were valid for analysis. Of them, 281 couples were identified to be at risk, Of the 281, 58 affected fetuses were identified and 55 pregnancies were terminated, whereas three did not accept pregnancy termination. All 6727 neonates at no risk were proven to be unaffected. The model had sensitivity and positive predictive value of 100% and 20%, respectively. The model could detect all of affected fetuses.

CONCLUSION

The model could prenatally identify affected fetuses with a detection rate and negative predictive value of 100%. The model was highly effective to prenatally detect affected fetuses with an acceptable false positive rate.

Analyzing the impact of private service on the cesarean section rate in public hospital Thailand

OBJECTIVE

To assess the cesarean section rate and compare the risk profiles of cesarean delivery in nulliparous women between private and non-private service.

MATERIALS AND METHODS

The computerized delivery records, collected from June 2006 to May 2009 at Rajavithi Hospital were retrospectively reviewed. Of these, 11,049 term singleton nulliparous pregnant women without maternal chronic medical disease were divided into two groups; private and non-private group. Demographic data, cesarean section rate, indication for cesarean section, time of delivery, maternal and neonatal outcomes were assessed and analyzed.

RESULTS

The cesarean section rate was markedly different between both groups. The cesarean rates of all pregnant women, women in private group and non-private group were 25.7% (2,841 out of 11,049), 67.3% (1,187 out of 1,765), and 17.8% (1,654 out of 9,284), respectively. The private group's odds of having a cesarean delivery was 9.44 times [95% confidence interval (95% CI) 8.372-10.655] higher than the non-private group's after adjusting for background differences (maternal age, race, gestational age and birth weight). The most common indications for cesarean delivery in private group were elderly gravida, unfavorable cervix and cephalopelvic disproportion. The private group had significantly higher operation rate in the office hours than that of non-private group (70.1 vs. 41.8%; p < 0.0001). After adjusted for background differences, postpartum hemorrhage was significant higher in private group. Conversely, there was fewer admission to neonatal intensive care unit in private group. Low Apgar score at 5 min and perinatal death were not statistically significant in both groups. No cesarean hysterectomy and maternal death in both groups were noted.

CONCLUSIONS

Private patients had a significantly higher rate of cesarean section than non-private patients. NICU admission was significantly lower in the private group, but postpartum hemorrhage was significantly higher. There were no significant differences in maternal mortality, low Apgar score at 5 min, perinatal death in both group. This study suggests that a significant number of cesarean sections among private services may be unnecessary. To safely reduce a cesarean section rate, an appropriate policy and guideline for auditing cesarean section among private service should be developed.

Pregnancy outcomes of Southeast Asian immigrant pregnant women compared with Thai pregnant women in Rajavithi Hospital

OBJECTIVE

To determine the pregnancy outcomes of Southeast Asian immigrant women compared to native Thai women in Rajavithi Hospital.

MATERIAL AND METHOD

A retrospective cohort study was conducted on singleton Southeast Asian immigrant pregnant women in Thailand between January 2007 and December 2008.

RESULTS

One thousand two hundred sixty immigrant pregnant women and 5040 controls were included. After adjusting the odds ratio, the cesarean section rate, postpartum hemorrhage, preterm birth, and neonatal intensive care unit admission of immigrant women are not different from native-born women. The incidence of low Apgar score at 5 minutes and perinatal death were significantly lower in the study group with an odds ratio of 0.506 (95% CI 0.29-0.89) and 0.295 (95% CI 0.10-0.83), respectively. Low birth weight was higher in the study group with an odds ratio of 1.707 (95% CI 1.45-2.01).

CONCLUSION

In Thailand, the cesarean section rate, postpartum hemorrhage, preterm birth, and neonatal intensive care unit admission of immigrant women are not different from native-born women. Foreign-born status confers a protective effect for low Apgar score at 5 minutes and perinatal death. However, the incidence of low birth weight in foreign-born women is higher than native-born women.

Midpregnancy cordocentesis training of maternal-fetal medicine fellows

OBJECTIVE

To describe systematic cordocentesis training among maternal-fetal medicine (MFM) fellows.

METHODS

During their 2-year training period, five MFM fellows, who had completed systematic model training, performed 1116 midpregnancy diagnostic cordocentesis procedures (mean, 223 (range, 185-259) procedures each) under expert supervision. The details of the procedures were recorded prospectively. Multiple pregnancies and those with fetal chromosomal or structural anomalies were excluded from analysis. The outcome measures included success rate, duration of the procedure, fetal loss and complications.

RESULTS

Of the 1116 procedures performed, 184 were excluded because of fetal abnormalities; the remaining 932 were available for analysis. Cordocentesis was performed on free-floating umbilical cord (79.3%) and at the placental insertion site (20.7%). There was an immediate complication of transient fetal bradycardia in 10% of cases. Individual success rates ranged from 98.1 to 100% and the mean cumulative success rate had plateaued by approximately 60 procedures. The overall fetal loss rate was 1.3%. The overall mean +/- SD duration of successful procedures was 4.4 +/- 4.7 min, individual mean durations ranging from 3.7 to 5.9 min.

CONCLUSIONS

MFM fellows with systematic training are able to perform cordocentesis with very high success rates, and with an acceptable procedure-related fetal loss rate. An intensive course of preclinical training with the model, and more than 60 procedures on patients under supervision is recommended.

Outcomes of pregnancies complicated by systemic lupus erythematosus (SLE)

OBJECTIVE

To assess the outcomes of pregnancies complicated by systemic lupus erythematosus (SLE) and evaluate the clinical course of the disease during pregnancy.

MATERIAL AND METHOD

The database of high-risk pregnancies between 1995 and 2006 was prospectively collected and searched for pregnancies with SLE. The medical records were reviewed

RESULTS

Sixty-eight pregnant women were identified during the period of the present study. Of 61 (89.7%) live births, 27 (39.7%) had preterm delivery and 20 (29.4%) had fetal growth restriction. Mean gestational age was 35.6 +/- 4.2 weeks. Mean neonatal birth weight was 2322 +/- 781 grams. There were seven (10.3%) perinatal deaths. Maternal SLE flares occurred in 20 (29.4%), seven in the first trimester, eight in the second trimester five in the third trimester, and none in the post partum period. Preeclampsia is the most common maternal complication (20.6%). There was a higher rate of flares if the pregnancy occurred while the disease was active. The predictor of poor pregnancies outcomes included flare-up of the disease, renal involvement, hypertension, and conception while the disease is active.

CONCLUSION

Active SLE prior to pregnancy is associated with a less favorable maternal and fetal outcome. Hypertension increased the risk of fetal loss and adverse outcome.