The prevalence and phenotypic manifestations of polycystic ovary syndrome (PCOS) among infertile Sudanese women: a cross-sectional study.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a global health problem associated with significant morbidity during reproductive age. Only a few published studies that address the clinical manifestations and phenotypic presentation of the disease have been conducted in Africa, including Sudan. Thus, this study aimed to evaluate the clinical and biochemical presentation of the different PCOS phenotypes among infertile Sudanese women. METHODS: A cross-sectional, descriptive study was conducted from January to December 2019. A total of 368 infertile women with PCOS (based on the Rotterdam criteria) were recruited from a fertility center in Khartoum, Sudan. Clinical, hormonal, and ultrasonographic characteristics were described and compared between the four phenotypes of PCOS. RESULTS: Majority (321 [87.2%]) of the women had oligo/anovulation (OA). Polycystic ovary morphology on ultrasound appeared in 236 (64.1%) women, acne in 171 (46.5%) women, acanthosis nigricans in 81 (22.0%) women, and hirsutism in 101 (27.4%) women. Phenotype D was the most prevalent among infertile Sudanese women (51.6%), followed by phenotype B (22.6%), phenotype C (18.2%), and phenotype A (7.6%). No statistical differences in the body mass index and hormonal profile between the four phenotypes were noted. Women with phenotype A were older and had high mean blood pressure, and a higher waist/hip ratio was observed among women with phenotype D. CONCLUSION: Unlike the global distribution of PCOS phenotypes, Sudanese women uniquely expressed phenotype D as the most prevalent. More epidemiological studies are needed in the region due to geographical, ethnic, and genetic variations.

Polycystic ovary syndrome (PCOS) is a global health problem associated with significant drawbacks during reproductive life. Few published studies have been conducted in Africa (including Sudan) addressing the clinical manifestations and phenotypic presentation of the disease. Therefore, we aimed to evaluate the clinical and biochemical presentation of the different PCOS phenotypes among infertile Sudanese women. A total of 368 infertile women with PCOS from a fertility center in Khartoum, Sudan, participated in the study. Clinical, hormonal, and ultrasonographic characteristics were described and compared between the four phenotype groups of PCOS. In this regard, Sudanese women uniquely expressed phenotype D as the most prevalent, and this does not match with the global distribution of PCOS phenotypes. Moreover, women with phenotype A were older and had high mean blood pressure, and a higher waist/hip ratio was observed among women with phenotype D. More epidemiological studies on this subject are needed in the region due to geographical, ethnic, and genetic variations.

Maternal age and miscarriage: A unique association curve in Sudan.

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. A cross-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years.

The calculated versus the measured glycosylated haemoglobin (HbA1c ) levels in patients with type 2 diabetes mellitus.

BACKGROUND: Diabetes mellitus (DM) is a chronic metabolic disorder that is increasing globally. It is associated with chronic complications that are more common among patients with poor glycaemic control. Glycosylated haemoglobin (HbA1c ) is the gold standard for monitoring glycaemic control. Measurements of HbA1c are relatively expensive and not available in some remote areas of developing countries. METHODS: We conducted a cross-sectional study to evaluate the agreement between the calculated and measured HbA1c levels. The equation to compute the calculated HbA1c also incorporated the fasting blood glucose (FBG) level and was as follows: HbA1c  = 2.6 + 0.03 × FBG (mg/dl). RESULT: We enrolled 290 patients with type 2 DM in this study. Of these, 204 (70.3%) were females and the mean (SD) age was 54.9 (12.8) years. The mean (SD) diabetes duration was 6.8 (5.5) years. There were 211 (72.8%) patients using oral hypoglycaemic agents, 62 (21.4%) were using insulin and 17 (5.9%) were using both insulin and oral hypoglycaemic agents. There was a borderline difference between the mean (SD) calculated and measured HbA1c levels (p = 0.054). There was a significant correlation between the calculated and measured HbA1c (r = 0.595, p < 0.001). However, there was no agreement between the calculated and measured HbA1c . The bias ±SD (limits of agreement) for calculated versus measured HbA1c was -1.008 ± 2.02% (-5.05, 2.032). CONCLUSION: Despite the presence of a significant correlation between the calculated and measured HbA1c , the calculated level has shown an unacceptable agreement with the measured HbA1c .

Reliability of glycosylated hemoglobin in the diagnosis of gestational diabetes mellitus.

BACKGROUND: Oral glucose tolerance test (OGTT) performed at 24-28 weeks gestation is the current recommended method to the diagnosis of gestational diabetes mellitus (GDM). Many recent studies investigating HbA1c in detecting GDM yield different results. There are no published data on HbA1c in the diagnosis of GDM in Sub-Saharan countries including Sudan. METHODS: A cross-sectional study was carried out at the antenatal care of Saad Abuelela Maternity Hospital, Khartoum, Sudan during the period from February to November 2018 to assess the reliability of HbA1c in the diagnosis of GDM. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups using a 75-g oral glucose tolerance test. RESULTS: Three hundred and forty-eight women were enrolled. The mean (SD) of the age, gravidity, and gestational age of the enrolled women were 27.8 (5.6) years, 2.36 (2.2) and 26.26 (2.43) weeks, respectively. Sixty-eight women (19.5%) had GDM. A poor productively for HbA1c in diagnosis GDM was shown (AUC = 0.62, 95% CI = 0.55-0.69). At HbA1c level of 4.150%, the sensitivity and specificity of the diagnosis for GDM were 76.51% and 37.85%, respectively. At HbA1c level of 5.850%, the sensitivity and specificity of the diagnosis for GDM were 13.24% and 91.43%, respectively. While there was no significant (Spearman) correlation between fasting blood glucose and HbA1c, there were significant correlations between HbA1c and OGTT 1 and 2 hours of OGTT. CONCLUSION: In this study, HbA1c has a poor reliability, insufficient sensitivity or specificity for use to diagnose GDM.

Association between maternal undernutrition among Sudanese women and newborn birth weight.

Background: Maternal undernutrition is a major health problem in developing countries. It is associated with maternal and perinatal morbidity, such as low birth weight (LBW), as well as mortality. This study aimed to investigate the effect of maternal undernutrition among pregnant women in Sudan on newborn birth weight. Methods: This was a cross-sectional study carried in the labor ward of Medani Maternity Hospital in central Sudan between June and December 2019. Data on the mothers' sociodemographic and obstetrics characteristics were collected through a questionnaire. Anthropometric measurements were obtained following standard procedures for both mothers and newborns. Linear logistic regressions were used to assess factors associated with birth weight. Results: Three hundred thirty-nine pairs of pregnant women and their newborns were enrolled in the study. Half of the women were primiparas (n = 170, 50.1%). The birth weight range was 1,330-4,640 g, and the mean (standard deviation (SD)) was 3,029.4 (613.0) g. The 10th and 90th centiles were 2,450 and 3,790 g, respectively. There was no significant difference in the birth weights of male (n = 160, 3,086.2 614.0 g) and female (n = 179, 2978.6 611.0 g; P = 0.107) newborns. In the linear regression, parity (43.1, P = 0.045), mid-upper arm circumference (MUAC) (39.3 cm, P = 0.001), gestational age (75.6 weeks, P = 0.017), and body mass index (BMI) (0.4 kg/m2, P = 0.006) were significantly associated with birth weight. There was no significant association between age, employment, a history of miscarriages, antenatal care, sex of the newborn, interpregnancy interval (IPI), and birth weight. Conclusion: The main finding was a significant association between parity, gestational age, MUAC, BMI, and birth weight.

Association between maternal serum 25-hydroxyvitamin D concentrations and the risk of pre-eclampsia in central Sudan: a case-control study.

BACKGROUND: There are few published data on the role of vitamin D concentrations during pregnancy in sub-Saharan Africa. Thus, the aim of the current study was to investigate the association between 25-hydroxyvitamin D (25[OH)]D) levels and pre-eclampsia. METHOD: A case-control study, with 60 women in each arm, was conducted in Medani Hospital in Sudan. The cases were women with pre-eclampsia and healthy pregnant women as controls. The medical and obstetric history was obtained using a questionnaire. The serum 25(OH)D concentrations were measured using ELISA. RESULTS: The median (IQR) of 25(OH)D concentration was significantly lower in women with pre-eclampsia than in the controls (10.0 [6.5] vs 18.3 [22.1] ng/mL). Fifty-three cases with pre-eclampsia (88%) and 36 cases in the control group (60%) had vitamin D deficiency (25(OH)D level≤20 ng/mL). Multivariate logistic regression showed that the 25(OH)D levels were negatively associated with pre-eclampsia (adjusted OR [AOR]=0.87, 95% CI 0.81 to 0.92). Vitamin D-deficient women were at a higher risk of pre-eclampsia (AOR=4.51, 95% CI 1.70 to 11.94). CONCLUSION: Low 25(OH)D levels were reported in women with pre-eclampsia and were an independent risk factor for pre-eclampsia.

Prevalence and associated factors of undernutrition among pregnant Sudanese women.

BACKGROUND: Maternal undernutrition is a global health challenge, and it is associated with significant maternal and perinatal morbidity and mortality. This study aimed to assess the prevalence and the factors associated with undernutrition among pregnant women in Sudan. METHODS: A cross-sectional study was carried out in Saad Abuelela Hospital in Khartoum, Sudan, from June to December 2019. Sociodemographic and obstetric characteristics were collected through a questionnaire. Mid-upper arm circumference was measured. Undernutrition was defined as a mid-upper arm circumference of <23 cm. Multiple logistic regression was used to assess the factors associated with maternal undernutrition. RESULTS: Of 1801 pregnant women, 226 (12.5%) were undernourished. Multivariable analysis revealed that ≤2 antenatal care clinic visits (adjusted OR [AOR]=3.06, 95% CI 1.68 to 5.58) was associated with undernutrition. Age (AOR=0.90, 95% CI 0.87 to 0.94) and haemoglobin levels (AOR=0.81, 95% CI 0.67 to 0.97) were negatively associated with undernutrition. There was no association between parity, education, interpregnancy interval, occupation and maternal undernutrition. CONCLUSIONS: Our findings indicated that 12.5% of the pregnant women in Khartoum were undernourished. More effort and action are need to improve the counselling and future inclusion of a supplemental food supply for undernourished pregnant women.

Association between breastfeeding and preeclampsia in parous women: a case -control study.

BACKGROUND: Preeclampsia is a global health problem and it is the main cause of maternal and perinatal morbidity and mortality. Breastfeeding has been reported to be associated with lower postpartum blood pressure in women with gestational hypertension. However, there is no published data on the role that breastfeeding might play in preventing preeclampsia. The aim of the current study was to investigate if breastfeeding was associated with preeclampsia in parous women. METHOD: A case-control study was conducted in Saad Abualila Maternity Hospital in Khartoum, Sudan, from May to December 2019. The cases (n = 116) were parous women with preeclampsia. Two consecutive healthy pregnant women served as controls for each case (n = 232). The sociodemographic, medical, and obstetric histories were gathered using a questionnaire. Breastfeeding practices and duration were assessed. RESULTS: A total of 98 (84.5%) women with preeclampsia and 216 (93.1%) women in the control group had breastfed their previous children. The unadjusted odds ratio (OR) of preeclampsia (no breastfeeding vs breastfeeding) was 3.55, 95% confidence interval (CI) 1.64,7.70 and p value = 0.001 based on these numbers. After adjusting for age, parity, education level, occupation, history of preeclampsia, history of miscarriage, body mass index groups the adjusted OR was 3.19, 95% CI 1.49, 6.82 (p value = 0.006). CONCLUSION: Breastfeeding might reduce the risk for preeclampsia. Further larger studies are required.

Prevalence of and risk factors for periodontal disease among pregnant women in an antenatal care clinic in Khartoum, Sudan.

OBJECTIVES: The aim was to investigate the prevalence of and factors associated with periodontal disease among pregnant Sudanese women. A cross-sectional study was conducted at the Antenatal Care Clinic of Saad Abualila Hospital (Khartoum, Sudan) from August to October 2018. Socioeconomic-demographic information and reproductive history were gathered using a questionnaire. Body mass index was computed from the weight and height. The diagnosis of periodontal disease was performed using criterion that also evaluated bleeding upon probing. RESULTS: Four hundred and four women were enrolled in the study, with a mean (SD) gestational age of 30.0 (8.7) weeks. Their mean (SD) age and parity were 27.0 (5.7) years and 1.6 (1.7), respectively. Ninety-seven (24.0%) of these 404 women had periodontal disease, which was mild, moderate and severe in 49 (12.1%), 36 (8.9%) and 12 (3.0%) women respectively, while 307 (76.0%) women had no periodontal disease. In logistic regression, age, parity, education, and brushing were not associated with periodontitis, but lower gestational age was associated with periodontal disease (OR = 0.96, 95% CI 0.94-0.99, P = 0.011).

Anaemia is associated with an increased risk for caesarean delivery.

OBJECTIVE: To investigate the association between anemia and cesarean delivery. METHODS: A case-control study was conducted in Saad Abu-Alela Hospital in Khartoum, Sudan from March 1 to November 30, 2107. The cases were women who had cesarean delivery; women who delivered vaginally were the controls. Obstetrics history was gathered using a questionnaire. RESULTS: There was no significant difference in age, parity, residence, job, education, and newborn gender between women who delivered by cesarean (n=130) and women who delivered vaginally (n=260). While mean (SD) of the body mass index (29.3 (5.4) kg/m2 vs 26.3 (5.6) kg/m2 , P<0.001) was significantly higher, hemoglobin level (103.0 (8.0) g/L vs 107.0 (8.0) g/L, P=0.001) was significantly lower in women who delivered by cesarean compared with women who delivered vaginally. In logistic regression analyses, age, gravidity, occupation, education, history of miscarriage, and newborn gender were not associated with cesarean delivery; overweight (adjusted odds ratio [AOR] 2.30, 95% confidence interval [CI] 1.24-4.26), obesity (AOR 7.17, 95% CI 3.64-14.13) and anemia (AOR 2.45, 95% CI 1.47-4. 11) were associated with cesarean delivery. CONCLUSION: The significant association between anemia and cesarean delivery has important implications for the prevention and treatment of anemia among these women.