Maternal exposure to ambient fine particulate matter and risk of premature rupture of membranes in Wuhan, Central China: a cohort study.

BACKGROUND: The associations between maternal exposure to ambient PM2.5 during pregnancy and the risk of premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM) are controversial. And no relevant study has been conducted in Asia. This study aimed to determine the association between maternal exposure to ambient PM2.5 during pregnancy and the risk of (P)PROM. METHODS: A cohort study including all singleton births in a hospital located in Central China from January 2015 through December 2017 was conducted. Multivariable logistic regression models, stratified analysis, generalized additive model, and two-piece-wise linear regression were conducted to evaluate how exposure to ambient PM2.5 during pregnancy is associated with the risks of PROM and PPROM. RESULTS: A total of 4364 participants were included in the final analysis, where 11.71 and 2.34% of births were complicated by PROM and PPROM, respectively. The level of PM2.5 exhibited a degree of seasonal variation, and its median concentrations were 63.7, 59.3, 55.8, and 61.8 µg/m3 for the first trimester, second trimester, third trimester, and the whole duration of pregnancy, respectively. After adjustment for potential confounders, PROM was positively associated with PM2.5 exposure (per 10 µg/m3) [Odds Ratio (OR) = 1.14, 95% Confidence Interval (CI), 1.02-1.26 for the first trimester; OR = 1.09, 95% CI, 1.00-1.18 for the second trimester; OR = 1.13, 95% CI, 1.03-1.24 for the third trimester; OR = 1.35, 95% CI, 1.12-1.63 for the whole pregnancy]. PPROM had positive relationship with PM2.5 exposure (per 10 µg/m3) (OR = 1.17, 95% CI, 0.94-1.45 for first trimester; OR = 1.11, 95% CI, 0.92-1.33 for second trimester; OR = 1.19, 95% CI, 0.99-1.44 for third trimester; OR = 1.53, 95% CI, 1.03-2.27 for the whole pregnancy) Positive trends between the acute exposure window (mean concentration of PM2.5 in the last week and day of pregnancy) and risks of PROM and PPROM were also observed. CONCLUSIONS: Exposure to ambient PM2.5 during pregnancy was associated with the risk of PROM and PPROM.

A comparison between pregnancy outcome in women in 15 to 19 and 20 to 35 years age group.

Background: Pregnancy is one of the most important periods of a woman's life and is influenced by many different factors. For years, it was assumed that teenage pregnancy can cause poor pregnancy outcome. The purpose of this study was to compare some pregnancy complications between 2 groups of 15 to 19 and 20 to 35 year- old primigravida pregnant women Methods: This was a cross- sectional study conducted on the data sheets of primigravida women who delivered their babies in a teaching hospital. A total of 3040 eligible women entered the study; of them, 280 (9.3%) were in the 15 to 19 years age group and 2756 in the 20 to 35 years age group. The 2 groups were compared for preeclampsia, PROM, preterm birth, SGA, placental abruption, and placenta previa. A logistic regression model was used for data analysis. Results: The women of the 2 groups significantly differed in BMI and socioeconomic background. The rate of preeclampsia (p=0.008), PROM (p=0.002), and preterm delivery (p=0.001) were less in the 15 to 19 years age group. The rate of placental abruption, placenta previa, IUFD, and SGA was not significantly different between the 2 groups. After multivariate regression analysis, preeclampsia (adjusted odd ratio= 2.157; 95% CI= 1.38- 4.21) and preterm delivery (adjusted odd ratio= 2.443; 95% CI= 1.78- 5.13) were found to be higher in the 20 to 35 years group. Conclusion: The risk of poor pregnancy outcome is not higher in teenage pregnancies compared to pregnancies in the 20 to 35 years age group if confounding factors, including socioeconomic factors, are carefully controlled.

Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand.

In 1988, the generalised HIV/AIDS epidemic in Thailand began and in the same year the first HIV-exposed infant in Thailand was born at King Chulalongkorn Memorial Hospital, Bangkok. From the early to mid-1990s, an epidemic wave of HIV-infected women and infants occurred. Heterosexual HIV transmission, as described in the Asian Epidemic Model, was the major mode of spread in Thailand, causing an increasing number of HIV-infected pregnant women. The early and concerted multi-sectoral response of Thai society reduced the prevalence of HIV infection in pregnant women from 2% in the mid-1990s to 0.6% in 2015 and mother-to-child transmission of HIV (MTCT) from an estimated 20-40% to 1.9%. Thus, Thailand became the first Asian country to achieve the World Health Organization's (WHO) targets for the elimination of MTCT. In this narrative review, the key historic evolutions of the science and policy of prevention of mother-to-child transmission of HIV (PMTCT) in Thailand that addressed the four prongs of the recommended WHO PMTCT strategy are described, and the lessons learned are discussed.