Maternal Pregnancy Hormone Concentrations in Countries with Very Low and High Breast Cancer Risk.

BACKGROUND: Breast cancer rates in Asia are much lower than in Europe and North America. Within Asia, rates are lower in Mongolia than in neighboring countries. Variation in pregnancy exposure to endogenous hormone concentrations may explain the differences, but data are lacking. METHODS: We measured maternal serum progesterone, prolactin, estradiol and estrone concentrations in the second half of pregnancy in a cross-sectional study of urban (n = 143-194 depending on the analyte) and rural (n = 150-193) Mongolian women, and U.S. women from Boston (n = 66-204). Medical records provided information on maternal and perinatal factors. Geometric mean hormones were estimated from standard linear models with the log-hormone as the dependent variable and country as the independent variable adjusted for maternal and gestational age at blood draw. RESULTS: Mean concentrations of prolactin (5722 vs. 4648 uIU/mL; p < 0.0001) and estradiol (17.7 vs. 13.6 ng/mL; p < 0.0001) were greater in Mongolian than U.S. women, while progesterone (147 vs. 201 ng/mL; p < 0.0001) was lower. Mean hormone concentrations were similar in rural and urban Mongolian women. Results were generally similar, with additional adjustment for gravidity, parity, height, body mass index at blood draw, education and alcohol use during pregnancy, and when stratified by offspring sex or parity. CONCLUSIONS: Mongolian women had greater concentrations of prolactin and estrogen and lower concentrations of progesterone than U.S. women, while hormone concentrations were similar in rural and urban Mongolian pregnancies. IMPACT: These data do not support the hypothesis that estrogen concentrations in pregnant women are lower in Mongolian compared with Caucasian women.

Comparison of seasonal serum 25-hydroxyvitamin D concentrations among pregnant women in Mongolia and Boston.

Adequate vitamin D status during pregnancy is important for developing fetal bone strength and density and may play a role in preventing a range of skeletal and non-skeletal diseases in both mothers and children. We previously identified Mongolian women of reproductive age to have the lowest vitamin D levels yet observed in any population globally, which renders this population uniquely important in vitamin D research. In this study, we measured the seasonal distribution of 25-hydroxyvitamin D (25(OH)D) concentration in 390 healthy third trimester pregnant women living in urban and rural Mongolia using DiaSorin LIAISON and compared this distribution to that of 206 third trimester women living in Boston, USA. Also, we analyzed seasonally-independent associations between (25(OH)D) levels and selected predictors in both groups using quantile regression. Mean 25(OH)D levels were significantly higher and less seasonal in Boston (seasonal range: 27.1 ±â€¯7.0-31.5 ±â€¯7.7 ng/ml) than in Mongolia (seasonal range: 11.2 ±â€¯3.9-19.2 ±â€¯6.7 ng/ml). Adjusting for month of blood draw, higher 25(OH)D levels were significantly associated with older age, lower gravidity, lower BMI, and lack of a college or university degree among Boston participants, however, only gravidity was robust to multivariable adjustment. No assessed characteristics were independently predictive in Mongolia, likely due to universally low 25(OH)D levels and a resulting lack of between-person variation. In conclusion, vitamin D status among pregnant Mongolians is severely depressed throughout the year and should be addressed through fortification and supplementation, while in the U.S., deficiency is associated with specific characteristics targetable through supplementation.

Prevalence of pregnancy hypertensive disorders in Mongolia.

OBJECTIVE: To estimate the prevalence of preeclampsia in a contemporary population of Mongolian women living in urban and rural areas. We determined the sensitivity and specificity of diagnosis based on established diagnostic criteria and assessed whether local diagnostic criteria were similar to those used in the US. STUDY DESIGN: Cross-sectional study of urban and nomadic pregnant women recruited in Ulaanbaatar (n=136) and rural provinces (n=85). MAIN OUTCOME MEASURES: Preeclampsia defined as hypertension new to pregnancy after 20weeks and proteinuria (or protein creatinine ratio ⩾0.3 and dipstick reading>+1) or in the absence of proteinuria, hypertension and onset of: renal insufficiency, impaired liver function, thrombocytopenia, pulmonary edema, cerebral/visual symptoms. Prevalence of preeclampsia based on established criteria was compared with prevalence based on local physician's diagnosis. RESULTS: Prevalence of local physician diagnosed preeclampsia was 9.5% (13.2% urban, 3.5% rural). Prevalence based on established diagnostic criteria was 4.1% (4.4% urban, 3.5% rural). Sensitivity of physician's diagnosis was 23.8%, specificity was 98.0%, false negative rate was 2.0% and false positive rate was 76.2%. While prevalence based on local physician's diagnosis was over double that based on diagnostic criteria, overdiagnosis did not result in adverse effects. Women fulfilling diagnostic criteria for preeclampsia had babies with higher birth weights than women who did not (p-value=0.006). CONCLUSION: The 4.1% prevalence of preeclampsia in Mongolia was consistent with global estimates of 2-8%, suggesting the pathophysiology of preeclampsia here may be similar to that found globally. Sensitivity of physician's diagnosis was low, specificity was high.

Telemedicine support of maternal and newborn health to remote provinces of Mongolia.

The telemedicine approach is a very much relevant and effective strategy for the Mongolian context of a huge geographical area with a sparse population and huge disparities in quality and access to health services. Through this initiative, it was possible to strengthen the capacity of service providers to provide timely and appropriate care, especially to mothers with pregnancy and childbirth complications. All the way through this network, health staff had easy access to information and support from experts; this improved access to knowledge is a positive benefit of the program. The early detection of pregnancy complications and timely management with the distance consultation of an expert team had contributed significantly to the reduction of maternal and newborn morbidity and mortality in project-selected provinces compared to non-project areas. The effective use of a modern telemedicine approach has been demonstrated as being effective in addressing the remoteness and rural-urban discrepancy in the quality of health care in Mongolia.