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1.
JNMA J Nepal Med Assoc ; 59(236): 380-383, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508532

RESUMO

INTRODUCTION: Women who conceive at advance age are at risk of pregnancy complications and adverse foetal outcome. This study aims to find out the prevalence of pregnancy at advance age in a teaching hospital. METHODS: A descriptive cross-sectional study was conducted between October 2019 to August 2020 at department of obstetrics and gynaecology of a tertiary care centre of Nepal, after obtaining ethical clearance from Institutional Review Committee (dated 03/09/2019 with ref no. 266) and informed consent from patient. Convenience sampling was done. All the patient who were ≥35 years and >28 weeks of gestation without any chronic illness were selected. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Women aged 35 years and above constituted 104 (5.73%) of the total deliveries of study period. Most were multigravida 72 (69.23%) and 23 (22.12%) had preterm delivery. Rate of caesarean section were higher in advance maternal age 69 (66.35%). Maternal complications such as Hypertensive disorder of pregnancy 9 (8.65%), and mal-presentation 15 (14.42%) were higher among them. Perinatal outcome in form of low birth weight 9 (8.65%) and perinatal death 5 (4.80%) were increased in those women. CONCLUSIONS: From this study, it can be concluded that prevalence of advanced age at pregnancy was lower than study done in developed country but it was similar to study in India and is increasing in Nepal.


Assuntos
Cesárea , Morte Perinatal , Idoso , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Idade Materna , Gravidez , Centros de Atenção Terciária
2.
Medicine (Baltimore) ; 100(34): e27063, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449499

RESUMO

ABSTRACT: Age above 35 years at the time of birth is generally referred to as advanced maternal age (AMA), and it could be a risk factor for various complications besides genetic changes in the fetus. The primary outcome of this study was to determine if AMA is associated with emergent cesarean delivery (CD) following induction of labor (IOL). The secondary outcomes were a composite of adverse maternal and perinatal outcomes following IOL.This retrospective observational study included women with singleton, live-born, cephalic, non-anomalous pregnancies undergoing IOL from 38 0/7 to 41 6/7 weeks of gestation. Mode of delivery and other maternal and neonatal outcomes were compared between women aged ≥35 (AMA) and <35 years. Multivariate logistic regression analyses were performed.A total of 307 nulliparous women underwent IOL (≥35 years n = 73, 23.8%; <35 years n = 234, 76.2%) and among them, 252 (82.1%) delivered vaginally. The rate of CD was significantly higher in women of AMA (31.5% vs 13.7%, P = .001). Multivariable analysis showed that AMA was independently associated with CD (odds ratio 3.04, 95% confidence interval 1.55-5.96, P = .001). The rate of instrumental deliveries was higher in the AMA group (19.6% vs 8.2%, P = .043) and hemoglobin decrease during delivery was similar between the 2 groups (1.90 ±â€Š1.25 vs 2.02 ±â€Š1.27 mg/dL, all P > .05). Regarding neonatal outcomes, there was no difference between the 2 groups in the neonatal intensive care unit admission rate and Apgar score <7 at 5 minutes (30.3% vs 30.1% and 6.0% vs 8.2%, respectively, all P > .05). Neonatal intubation rate and severe respiratory problems were non-significantly higher in AMA (3.8% vs 2.7% and 3.4% vs 1.4%, respectively, all P > .05).AMA was associated with an approximately three-fold increased likelihood of birth by CD and operative vaginal delivery in uncomplicated nulliparous women following IOL. However, we found no evidence that IOL in primigravid women of AMA increases adverse maternal and perinatal outcomes as compared with women aged <35 years except the high prevalence of CD and operative vaginal delivery.


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Induzido/estatística & dados numéricos , Idade Materna , Resultado da Gravidez/epidemiologia , Adulto , Índice de Massa Corporal , Parto Obstétrico/estatística & dados numéricos , Feminino , Número de Gestações , Humanos , Tempo de Internação , Modelos Logísticos , Pessoa de Meia-Idade , Readmissão do Paciente , Gravidez , Estudos Retrospectivos , Fatores de Risco
3.
Nutrients ; 13(7)2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34371882

RESUMO

There are numerous dietary recommendations during pregnancy. However, there are limited recommendations during the lactation period, a nutritionally vulnerable period for women. The Mediterranean Diet and adherence to the Healthy Food Pyramid (HFP) is considered as the standard for healthy eating. In this study, we investigated the differences in adherence to the HFP in pregnant, lactating, and non-pregnant/non-lactating (NPNL) women concerning sociodemographic factors. A sociodemographic and nutritional and lifestyle questionnaire (AP-Q) were used to assess adherence to the HFP, including lifestyle. The AP-Q score ranges from 0 to 10 meaning the higher the score, the greater the adherence to the HFP. Lactating women had the lowest AP-Q score (6.13 [5.31; 6.82]) compared to the pregnant (6.39 [5.56; 7.05]) and NPNL women (6.27 [5.43; 6.88]), while pregnant women had the highest scores. Maternal age was positively correlated with AP-Q score in pregnant (rho = 0.22; p-Value < 0.001) and lactating women (rho = 0.18; p-Value < 0.001), but not in NPNL women. Educational level and monthly income had a positive influence on the degree of adherence to the HFP. In conclusion, breastfeeding mothers of young age and low socioeconomic and educational level would be the target population to carry out nutritional interventions that improve their adherence to the HFP. The knowledge gained from this study can help to design recommendation guidelines and nutritional educational interventions for a given population.


Assuntos
Dieta Saudável/psicologia , Comportamento Alimentar/psicologia , Fidelidade a Diretrizes/estatística & dados numéricos , Lactação/psicologia , Gestantes/psicologia , Adolescente , Adulto , Aleitamento Materno/psicologia , Inquéritos sobre Dietas , Dieta Saudável/normas , Dieta Mediterrânea/psicologia , Feminino , Humanos , Renda , Estilo de Vida , Idade Materna , Política Nutricional , Estado Nutricional , Gravidez , Inquéritos e Questionários , Adulto Jovem
4.
Einstein (Sao Paulo) ; 19: eAO5663, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34406314

RESUMO

OBJECTIVE: To determine the impact of risk factors on infant mortality in the Metropolitan Region of São Paulo according to maternal and neonate characteristics, as well as mode of delivery. METHODS: An ecological, quantitative study based on secondary data retrieved from infant mortality and live birth data systems. Data from 39 municipalities located in the Metropolitan Region of São Paulo were analyzed. Newborn and maternal variables were extracted from the Information Technology Department of the Unified Health System. Absolute and relative frequencies were presented, as well as linear regression and Pearson´s correlation coefficient. RESULTS: The following maternal profile prevailed from 2006 to 2016: 8 to 11 years of education (ß=73.58; p=0.023), age between 30 and 34 years (ß=19.04; p=0.015) and delivery by cesarean section (ß=39.59; p=0.009) after full-term pregnancy (ß=-14.20; p=0.324). Mortality rates decreased in neonates compared to other age groups (ß=-25.30; p<0.001). Infant mortality rates tended to be higher among women experiencing pre-term (r=0.86; p<0.001) or post-term (r=0.95; p<0.001) gestation. CONCLUSION: Maternal age and level of education increased among women giving birth in the Metropolitan Region of São Paulo from 2006 to 2016. These were relevant factors for infant mortality rate reduction.


Assuntos
Cesárea , Mortalidade Infantil , Adulto , Brasil/epidemiologia , Escolaridade , Feminino , Humanos , Lactente , Recém-Nascido , Idade Materna , Gravidez
5.
BMC Public Health ; 21(1): 1512, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353303

RESUMO

BACKGROUND: Evidences suggest that early processed food (PF) consumption may cause harm to infant health. During the first 6 months of life, it is not known whether the timing and quantity of this food group can impact breastfeeding and growth. The aim of the study was to analyze the associations between time of introduction and quantity of infant PF consumption with duration of breastfeeding and infant growth at 6 months of age. METHODS: Data were longitudinally collected in six interviews, from birth to 6 months, in a sample of Brazilian newborns with adverse intrauterine environments. PF consumption was calculated by gravity score of processed foods (GSPF) in relation to feeding supply quality and time. For the analysis, the scores were divided into tertiles, making scores severities: Null, Mild, Moderate, and Severe. The interaction between GSPF and breastfeeding (exclusive and non-exclusive) and growth parameters (analyzed in Z-scores, by weight for height, weight for age, and body mass index for age) was tested. RESULTS: A total of 236 infants were included in the study. Greater GSPF were associated with better rates of breastfeeding practices and higher growth indicators scores in the sixth month of infants. These findings were confirmed after adjustment for family income, maternal age, pre-gestational body mass index, and growth z scores at birth. CONCLUSION: The harms of eating PF in relation to breastfeeding and infant growth are more evident the greater and earlier they are consumed. Future studies should explore interventions to reduce and delay the consumption of these foods to prevent adverse health outcomes in later life.


Assuntos
Aleitamento Materno , Fenômenos Fisiológicos da Nutrição do Lactente , Índice de Massa Corporal , Criança , Fast Foods , Feminino , Humanos , Lactente , Alimentos Infantis , Recém-Nascido , Idade Materna
6.
BMJ Open ; 11(7): e046582, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230019

RESUMO

OBJECTIVE: This study aimed to compare the health economic value of a non-invasive prenatal testing (NIPT) strategy against a second-trimester triple screening (STS) strategy for the detection of Down syndrome based on real-world data from China. DESIGN: A decision-analytical model was developed to compare the cost-effectiveness of five strategies from a societal perspective. Cost and probability input data were obtained from the real-world surveys and published sources. SETTING: China. PARTICIPANTS: Women with a singleton pregnancy. INTERVENTIONS: The five strategies for screening were: (A) maternal age with STS (no NIPT); (B) STS plus NIPT screening; (C) age-STS plus NIPT screening (the currently referral strategy in China); (D) maternal age with NIPT screening and (E) universal NIPT screening. MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratios (ICERs) per additional Down syndrome case terminated, univariate and probabilistic sensitivity analysis and cost-effectiveness acceptability curves were obtained. RESULTS: Strategy A detected the least number of Down syndrome cases. Compared with the cheapest Strategy B, Strategy D had the lowest ICER (incremental cost, US$98 944.85 per additional Down syndrome case detected). Strategy D had the highest probability of being cost-effective at the willingness-to-pay level between US$110 000.00 and US$535 000.00 per additional Down syndrome case averted. Strategy E would not be cost-effective unless the unit cost of the NIPT could be decreased to US$60.50. CONCLUSION: Introducing NIPT screening strategies was beneficial over the use of STS strategy alone. Evaluating maternal age in combination with the NIPT screening strategy performs better than China's currently referral strategy in terms of cost-effectiveness and safety. Lowering the price of NIPT and optimising payment methods are effective measures to promote universal NIPT strategies in China.


Assuntos
Síndrome de Down , China , Análise Custo-Benefício , Síndrome de Down/diagnóstico , Feminino , Humanos , Idade Materna , Gravidez , Diagnóstico Pré-Natal
7.
Int J Mol Sci ; 22(14)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34299077

RESUMO

BACKGROUND: Depression is a common mood disorder during pregnancy impacting one in every seven women. Children exposed to prenatal depression are more likely to be born at a low birth weight and develop chronic diseases later in life. A proposed hypothesis for this relationship between early exposure to adversity and poor outcomes is accelerated aging. Telomere length has been used as a biomarker of cellular aging. We used high-resolution telomere length analysis to examine the relationship between placental telomere length distributions and maternal mood symptoms in pregnancy. METHODS: This study utilised samples from the longitudinal Grown in Wales (GiW) study. Women participating in this study were recruited at their presurgical appointment prior to a term elective caesarean section (ELCS). Women completed the Edinburgh Postnatal Depression Scale (EPDS) and trait subscale of the State-Trait Anxiety Inventory (STAI). Telomere length distributions were generated using single telomere length analysis (STELA) in 109 term placenta (37-42 weeks). Multiple linear regression was performed to examine the relationship between maternally reported symptoms of depression and anxiety at term and mean placental telomere length. RESULTS: Prenatal depression symptoms were significantly negatively associated with XpYp telomere length in female placenta (B = -0.098, p = 0.026, 95% CI -0.184, -0.012). There was no association between maternal depression symptoms and telomere length in male placenta (B = 0.022, p = 0.586, 95% CI -0.059, 0.103). There was no association with anxiety symptoms and telomere length for either sex. CONCLUSION: Maternal prenatal depression is associated with sex-specific differences in term placental telomeres. Telomere shortening in female placenta may indicate accelerated placental aging.


Assuntos
Transtornos de Ansiedade/complicações , Depressão/complicações , Placenta/patologia , Encurtamento do Telômero , Transtornos de Ansiedade/psicologia , Depressão/psicologia , Feminino , Idade Gestacional , Humanos , Lactente , Masculino , Idade Materna , Placenta/metabolismo , Gravidez , Fatores Sexuais
8.
JAMA ; 326(2): 145-153, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34255007

RESUMO

Importance: Timely delivery of infants suspected of having fetal growth restriction (FGR) is a balance between preventing stillbirth and minimizing prematurity, particularly because many infants with suspected FGR have normal growth. Objective: To explore the association between iatrogenic delivery for suspected FGR and childhood school outcomes. Design, Setting, and Participants: A retrospective whole-population cohort study linking perinatal data from births 32 weeks' or more gestation between January 1, 2003, to December 31, 2013, to developmental and educational test scores at preparatory school, and at school grades 3, 5, and 7 in Victoria, Australia. Follow-up was concluded in 2019. Exposures: Suspicion or nonsuspicion of FGR, presence or absence of iatrogenic delivery (defined as early induction of labor or cesarean delivery prior to labor) for suspected FGR, and presence or absence of small for gestational age (SGA). Main Outcomes and Measures: The coprimary outcomes were being in the bottom 10th percentile on 2 or more of 5 developmental domains at school entry and being below the national minimum standard on 2 or more of 5 educational domains in grades 3, 5, or 7. Results: In the birth population of 705 937 infants, the mean gestation at birth was 39.1 (SD, 1.5) weeks and the mean birth weight was 3426 (SD, 517) grams. The birth population linked to 181 902 children with developmental results and 425 717 children with educational results. Compared with infants with severe SGA (birth weight <3rd percentile) not suspected of having FGR, infants with severe SGA delivered for suspected FGR were born earlier (mean gestation, 37.9 weeks vs 39.4 weeks). They also had a significantly increased risk of poor developmental outcome at school entry (16.2% vs 12.7%; absolute difference, 3.5% [95% CI, 0.5%-6.5%]); adjusted odds ratio [aOR], 1.36 [95% CI, 1.07-1.74]) and poor educational outcomes in grades 3, 5, and 7 (for example, in grade 7: 13.4% vs 10.5%; absolute difference, 2.9% [95% CI, 0.4%-5.5%]); aOR, 1.33 [95% CI, 1.04-1.70]). There was no significant difference between infants with normal growth (birth weight ≥10th percentile) delivered for suspected FGR and those not suspected of having FGR in developmental outcome (8.6% vs 8.1%; absolute difference, 0.5% [95% CI, -1.1% to 2.0%]); aOR, 1.17 [95% CI, 0.95-1.45]) or educational outcome in grade 3, 5 or 7, despite being born earlier (mean gestation, 38.0 weeks vs 39.1 weeks). Conclusions and Relevance: In this exploratory study conducted in Victoria, Australia, iatrogenic delivery of infants with severe SGA due to suspected FGR was associated with poorer school outcomes compared with infants with severe SGA not suspected of having FGR. Iatrogenic delivery of infants with normal growth due to suspected FGR was not associated with poorer school outcomes compared with infants with normal growth not suspected of having FGR.


Assuntos
Cesárea , Escolaridade , Retardo do Crescimento Fetal , Recém-Nascido Pequeno para a Idade Gestacional , Trabalho de Parto Induzido , Adulto , Criança , Deficiências do Desenvolvimento/epidemiologia , Avaliação Educacional , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Idade Materna , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Nascimento Prematuro , Estudos Retrospectivos , Vitória/epidemiologia , Adulto Jovem
10.
Ecol Lett ; 24(10): 2113-2122, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34265869

RESUMO

Many organisms show signs of deterioration with age in terms of survival and reproduction. We tested whether intraspecific variation in such senescence patterns can be driven by resource availability or reproductive history. We did this by manipulating nutritional stress and age at first reproduction and measuring age-dependent reproductive output in tsetse (Glossina morsitans morsitans), a viviparous fly with high maternal allocation. Across all treatments, offspring weight followed a bell-shaped curve with maternal age. Nutritionally stressed females had a higher probability of abortion and produced offspring with lower starvation tolerance. There was no evidence of an increased rate of reproductive senescence in nutritionally stressed females, or a reduced rate due to delayed mating, as measured by patterns of abortion, offspring weight or offspring starvation tolerance. Therefore, although we found evidence of reproductive senescence in tsetse, our results did not indicate that resource allocation trade-offs or costs of reproduction increase the rate of senescence.


Assuntos
Envelhecimento , Reprodução , Feminino , Humanos , Idade Materna , Gravidez
11.
Nutrients ; 13(6)2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34199741

RESUMO

(1) Background: Recent evidence reported a reduced tolerance of macronutrient parenteral intakes in subjects in critically ill conditions. We designed a prospective cohort study to evaluate the effects of hyperglycemia (HG) related to parenteral nutrition (PN) on neurodevelopment (NDV) in survived preterm newborns. (2) Methods: Enrolled newborns with gestational age < 32 weeks or birth weight < 1500 g, were divided in two cohorts: (A) exposed to moderate or severe HG (glucose blood level > 180 mg/dL) in the first week of life; (B) not exposed to HG. We considered as the primary outcome the rate of preterm newborns survived without NDV delay at 24 months of life, evaluated with Bayley Scales of Infants Development III edition. (3) Results: We analyzed 108 (A 32 vs. B 76) at 24 months of life. Newborns in cohort A showed a higher rate of cognitive and motor delay (A 44% vs. B 22 %, p = 0.024; A 38% vs. B 8%, p < 0.001). When adjusting for background characteristics, HG remained a risk factor for motor delay. (4) Conclusions: High nutritional intakes through PN soon after birth increase the risk of HG. The consequences of this severe metabolic complication affect long-term NDV and survival in preterm newborns.


Assuntos
Hiperglicemia/etiologia , Nutrição Parenteral Total , Nutrição Parenteral , Adulto , Peso ao Nascer , Glicemia , Desenvolvimento Infantil , Estudos de Coortes , Idade Gestacional , Humanos , Hiperglicemia/mortalidade , Recém-Nascido , Doenças do Recém-Nascido , Modelos Logísticos , Idade Materna , Análise Multivariada , Transtornos do Neurodesenvolvimento/etiologia , Estudos Prospectivos
12.
Medicine (Baltimore) ; 100(25): e26387, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160417

RESUMO

RATIONALE: Group B Streptococcus (GBS) remains a principal pathogen causing neonatal sepsis and meningitis, particularly in premature infants with relatively insufficient immunity. Recurrence may occur uncommonly, largely associated with subclinical mucosal persistence or repetitive exposure to exogenous sources. White matter injury (WMI) including cystic periventricular leukomalacia (PVL) has been associated with intrauterine infection/inflammation, and neonatal infection as a more significant predictor including postnatal sepsis and recurrent infection, even without microbial neuroinvasion. Furthermore, clinical and experimental evidence of WMI by some bacteria other than GBS without central nervous system invasion has been reported. However, there is little evidence of WMI associated with neonatal GBS sepsis in the absence of meningitis in the literature. PATIENT CONCERNS: A newborn at 30+4 weeks' gestation with low birthweight presented with 2 episodes (with a 13-day interval with no antibiotic therapy) of neonatal sepsis culture-proven for GBS with early-onset presentation after clinical chorioamnionitis via vertical GBS transmission and the associated conditions including prematurity-related neonatal immunodeficiency and persistent mucosal GBS carriage after the first antibiotic treatment. The perinatal GBS infection was complicated by progressive WMI presenting with ventriculomegaly and cystic PVL without a definite evidence of meningitis, intraventricular hemorrhage, and documented cerebral hypoxia or hypoperfusion conditions including septic shock. DIAGNOSES: Recurrent group B streptococcal sepsis and cystic PVL with ventriculomegaly. INTERVENTIONS: Two episodes of GBS sepsis were treated with 15-day parenteral antibiotic therapy, respectively. OUTCOMES: Resolution of the recurrent GBS sepsis without further relapses, however, complicated by WMI and subsequent about 6 months delay in motor development at 12 months' corrected age. LESSONS: This case suggests WMI associated with GBS bacteremia without central nervous system entry by viable GBS and also shows that in premature infants, intrauterine GBS infection with no interventions may lead to extensive and persistent GBS colonization, early-onset and recurrent GBS disease, and WMI. Postnatal as well as intrauterine infection/inflammation controls with maternal prophylaxis may be pivotal for prevention and limiting the magnitude of neurologic injury.


Assuntos
Leucomalácia Periventricular/microbiologia , Sepse Neonatal/microbiologia , Complicações Infecciosas na Gravidez/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus agalactiae/isolamento & purificação , Administração Intravenosa , Antibacterianos/administração & dosagem , Corioamnionite/diagnóstico , Corioamnionite/microbiologia , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/microbiologia , Quimioterapia Combinada/métodos , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/microbiologia , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Transmissão Vertical de Doenças Infecciosas , Leucomalácia Periventricular/diagnóstico , Leucomalácia Periventricular/patologia , Imageamento por Ressonância Magnética , Masculino , Idade Materna , Sepse Neonatal/diagnóstico , Sepse Neonatal/terapia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Recidiva , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Substância Branca/diagnóstico por imagem , Substância Branca/microbiologia , Substância Branca/patologia , Adulto Jovem
13.
Environ Health Prev Med ; 26(1): 65, 2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34118886

RESUMO

BACKGROUND: In Ethiopia, despite the considerable improvement in immunization coverage, the burden of defaulting from immunization among children is still high with marked variation among regions. However, the geographical variation and contextual factors of defaulting from immunization were poorly understood. Hence, this study aimed to identify the spatial pattern and associated factors of defaulting from immunization. METHODS: An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS 2016) data was used. A total of 1638 children nested in 552 enumeration areas (EAs) were included in the analysis. Global Moran's I statistic and Bernoulli purely spatial scan statistics were employed to identify geographical patterns and detect spatial clusters of defaulting immunization, respectively. Multilevel logistic regression models were fitted to identify factors associated with defaulting immunization. A p value < 0.05 was used to identify significantly associated factors with defaulting of child immunization. RESULTS: A spatial heterogeneity of defaulting from immunization was observed (Global Moran's I = 0.386379, p value < 0.001), and four significant SaTScan clusters of areas with high defaulting from immunization were detected. The most likely primary SaTScan cluster was seen in the Somali region, and secondary clusters were detected in (Afar, South Nation Nationality of people (SNNP), Oromiya, Amhara, and Gambella) regions. In the final model of the multilevel analysis, individual and community level factors accounted for 56.4% of the variance in the odds of defaulting immunization. Children from mothers who had no formal education (AOR = 4.23; 95% CI: 117, 15.78), and children living in Afar, Oromiya, Somali, SNNP, Gambella, and Harari regions had higher odds of having defaulted immunization from community level. CONCLUSIONS: A clustered pattern of areas with high default of immunization was observed in Ethiopia. Both the individual and community-level characteristics were statistically significant factors of defaulting immunization. Therefore, the Federal Ethiopian Ministry of Health should prioritize the areas with defaulting of immunization and consider the identified factors for immunization interventions.


Assuntos
Imunização/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Análise por Conglomerados , Demografia , Etiópia , Feminino , Geografia , Inquéritos Epidemiológicos , Humanos , Esquemas de Imunização , Lactente , Masculino , Idade Materna , Pessoa de Meia-Idade , Análise Multinível , Fatores de Risco , Análise Espacial , Adulto Jovem
14.
Hum Reprod ; 36(8): 2148-2156, 2021 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-34143887

RESUMO

STUDY QUESTION: Can sperm donation increase live birth rates following ICSI in advanced maternal age (AMA) patients? SUMMARY ANSWER: Sperm donation increases the live birth rate in AMA ICSI cycles. WHAT IS KNOWN ALREADY: In ICSI practice, sperm donation has been predominantly applied to overcome male infertility. The involvement of paternal age and lower sperm quality in the severe reduction in fertility observed in AMA patients remains to be clarified. STUDY DESIGN, SIZE, DURATION: Retrospective multicenter cohort study including data generated between 2015 and 2019 from 755 ICSI cycles achieving a fresh embryo transfer, of which 337 were first homologous cycles (normozoospermic partner sperm and homologous oocytes) and 418 were first sperm donation cycles (donor sperm and homologous oocytes). The association of sperm origin (partner vs donor) with live birth was assessed by multivariate analysis in non-AMA (<37 years, n = 278) and AMA (≥37 years, n = 477) patients, separately, including in the model all variables previously found to be associated with live birth in a univariate analysis (number of MII oocytes recovered, number of embryos transferred, and maternal age). ICSI outcomes were compared between sperm donation and homologous cycles in overall, non-AMA and AMA patients. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study was conducted in three fertility clinics and included 755 Caucasian patients aged 24-42 years undergoing their first homologous or sperm donation ICSI cycle achieving a fresh embryo transfer. MAIN RESULTS AND THE ROLE OF CHANCE: The multivariate analysis revealed that sperm donation was positively associated with the likelihood of a live birth independently of all other variables tested in AMA (P = 0.02), but not in non-AMA patients. Live birth, delivery, and miscarriage rates differed substantially between sperm donation and homologous AMA cycles; live birth and delivery rates were 70-75% higher (25.4% vs 14.5% and 22.5% vs 13.5%, respectively; P < 0.01), while miscarriage occurrence was less than half (18.0% vs 39.5%; P < 0.01) in sperm donation compared to homologous AMA cycles. LIMITATIONS, REASONS FOR CAUTION: This study is limited by its retrospective nature, differences in patients profiles between sperm donation and homologous-control groups and varying proportion of donor cycles between fertility centers, although these variations have been controlled for in the statistical analysis. WIDER IMPLICATIONS OF THE FINDINGS: The findings suggest that sperm donation increases live birth rates while reducing miscarriage occurrence in AMA patients, and thus may be a valid strategy to improve ICSI outcomes in this growing and challenging patient group. STUDY FUNDING/COMPETING INTEREST(S): N/A. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Coeficiente de Natalidade , Injeções de Esperma Intracitoplásmicas , Adulto , Estudos de Coortes , Feminino , Fertilização In Vitro , Humanos , Nascido Vivo , Masculino , Idade Materna , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Espermatozoides
15.
Am J Obstet Gynecol MFM ; 3(5): 100405, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34091061

RESUMO

OBJECTIVE: Fetal malpresentation complicates approximately 3% to 4% of all term births. It requires special considerations for delivery and exposes the mother and neonate to obstetrical interventions and potential adverse outcomes, such as umbilical cord prolapse, head entrapment and birth trauma, hypoxic ischemic encephalopathy, cesarean delivery, and cesarean delivery-related complications. We set out to explore the maternal and fetal factors associated with noncephalic malpresentation at term, with specific interest on the impact of maternal race and ethnicity on fetal malpresentation. STUDY DESIGN: This was a retrospective analysis of the Centers for Disease Control and Prevention Natality Live Birth database for the years from 2016 through 2018. All term, singleton deliveries for the following racial and ethnic groups were included: non-Hispanic White, non-Hispanic Black, Asian, and Hispanic. Race and ethnicity were assigned based on self-identification and individuals with >1 racial category were excluded from the analysis. Malpresentation was defined as a noncephalic presentation at term and included breech and transverse presentations. The malpresentation group included all noncephalic births and cephalic births that occurred following successful external cephalic version, whereas all other cephalic births served as controls. A multivariable logistic regression analysis was used to assess the rate of malpresentation, with adjustment for potential confounders including maternal age, race and ethnicity, parity, birthweight, fetal malformations, malformations of the central nervous system (CNS), and chromosomal anomalies. The results are displayed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Statistical significance was set at a P value of <.05. Institutional review board approval was not required because the de-identified data are publicly available through a data use agreement. RESULTS: There were 9,692,203 term, singleton births during the study period. The malpresentation group included 354,689 births (3.66% of the total). The Table shows the rate of malpresentation for various maternal and fetal factors. We found a substantial racial and ethnic disparity in the malpresentation rates. Non-Hispanic White women had the highest malpresentation risk, whereas non-Hispanic Black women had the lowest risk (3.93% vs 2.81%; aOR, 1.38; 95% CI, 1.36-1.39). Hispanic and Asian women were also at increased risk for malpresentation when compared with non-Hispanic Black women (aOR, 1.30; 95% CI, 1.29-1.32 and aOR, 1.12; 95% CI, 1.10-1.14, respectively). In addition, several maternal and fetal conditions were noted to be associated with an increased risk for malpresentation at term, including older maternal age (aOR, 2.81; 95% CI, 2.74-2.88; for patients >40 years), nulliparity (aOR, 1.50; 95% CI, 1.48-1.51), low birthweight (aOR, 1.80; 95% CI, 1.77-1.83 for birthweight under 2500 g), and fetal malformations of the CNS and chromosomal anomalies (aOR, 3.53; 95% CI, 3.06-4.06 and aOR, 2.32; 95% CI, 2.05-2.63, respectively). CONCLUSION: Based on a large US population database, we identified several maternal, fetal, and racial and ethnic factors that are associated with an increased rate of noncephalic malpresentation at term. Specifically, fetal CNS malformations, congenital or chromosomal anomalies, advanced maternal age, low birthweight, and nulliparity are risk factors for noncephalic presentation. Interestingly, non-Hispanic White women have the highest risk for malpresentation, whereas non-Hispanic Black women have the lowest risk. Previous publications found that low birthweight, advanced maternal age, nulliparity, and congenital fetal malformations are risk factors for malpresentation.1-3 Nonetheless, the current data available on race and ethnicity are sporadic, with limited reports suggesting that sub-Saharan ethnicity is associated with a lower rate of malpresentation2 and that White race is associated with a higher rate.4 We present a large-scale, nationwide US-based study to confirm the racial and ethnic disparity regarding malpresentation in the United States. This may be explained by the known variation in the shape of the bony birth canal in different racial and ethnic groups and populations from different geographic locations.5 Further investigation is needed to explore the racial and ethnic disparity described.


Assuntos
Grupos Étnicos , Apresentação no Trabalho de Parto , Adulto , Causalidade , Feminino , Humanos , Recém-Nascido , Idade Materna , Gravidez , Estudos Retrospectivos , Estados Unidos
16.
Nat Commun ; 12(1): 3270, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34075035

RESUMO

Little is known about the long-term neurological development of children diagnosed with congenital Zika infection at birth. Here, we report the imaging and clinical outcomes up to three years of life of a cohort of 129 children exposed to Zika virus in utero. Eighteen of them (14%) had a laboratory confirmed congenital Zika infection at birth. Infected neonates have a higher risk of adverse neonatal and early infantile outcomes (death, structural brain anomalies or neurologic symptoms) than those who tested negative: 8/18 (44%) vs 4/111 (4%), aRR 10.1 [3.5-29.0]. Neurological impairment, neurosensory alterations or delays in motor acquisition are more common in infants with a congenital Zika infection at birth: 6/15 (40%) vs 5/96 (5%), aRR 6.7 [2.2-20.0]. Finally, infected children also have an increased risk of subspecialty referral for suspected neurodevelopmental delay by three years of life: 7/11 (64%) vs 7/51 (14%), aRR 4.4 [1.9-10.1]. Infected infants without structural brain anomalies also appear to have an increased risk, although to a lesser extent, of neurological abnormalities. It seems paramount to offer systematic testing for congenital ZIKV infection in cases of in utero exposure and adapt counseling based on these results.


Assuntos
Desenvolvimento Infantil , Malformações do Sistema Nervoso/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Infecção por Zika virus/complicações , Adolescente , Adulto , Pré-Escolar , Feminino , Guiana Francesa/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Idade Materna , Malformações do Sistema Nervoso/etiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/etiologia , Medição de Risco/estatística & dados numéricos , Adulto Jovem , Zika virus/isolamento & purificação , Infecção por Zika virus/congênito , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/virologia
17.
Afr J Reprod Health ; 25(1): 129-137, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077119

RESUMO

Miscarriage is a common adverse pregnancy outcome in childbearing and an increasing global reproductive health problem. This study explored 1) the national prevalence of the first trimester (≤12 weeks) miscarriage among women (15-49 years) in Ghana, and 2) the influence of first-trimester antenatal care (ANC) visits on miscarriage risk. A cross-sectional study using the Demographic Health Survey (DHS- 2017) on maternal health in Ghana was conducted. We used a nationally representative subsample of (7,846) women with no or early ANC visit of the initial sample (25,062). Women with late ANC visit (≥12 weeks) and those who were never pregnant or had not given birth at the time of the survey were excluded from this analysis. We performed multivariable Poisson regression to estimate miscarriage risk (RR), its associated risk factors, and national prevalence. The national first-trimester miscarriage prevalence was 19.1%. Increasing maternal age and urban residence were significantly associated with the risk of first- trimester miscarriage (p <0.001) while early ANC visits lower the risk of miscarriage by 43% (p=0.0246). We found that first trimester ANC visit decreases miscarriage risk in Ghana and highlights the important role of early ANC visits in reducing miscarriages.


Assuntos
Aborto Espontâneo/epidemiologia , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Aborto Espontâneo/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Idade Materna , Gravidez , Primeiro Trimestre da Gravidez , Características de Residência , População Rural , População Urbana , Adulto Jovem
18.
JAMA ; 325(22): 2285-2293, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34100870

RESUMO

Importance: Seasonal influenza vaccination in pregnancy can reduce influenza illness among pregnant women and newborns. Evidence is limited on whether seasonal influenza vaccination in pregnancy is associated with adverse childhood health outcomes. Objective: To assess the association between maternal influenza vaccination during pregnancy and early childhood health outcomes. Design, Setting, and Participants: Retrospective cohort study, using a birth registry linked with health administrative data. All live births in Nova Scotia, Canada, between October 1, 2010, and March 31, 2014, were included, with follow-up until March 31, 2016. Adjusted hazard ratios (HRs) and incidence rate ratios (IRRs) with 95% confidence intervals were estimated while controlling for maternal medical history and other potential confounders using inverse probability of treatment weighting. Exposures: Seasonal influenza vaccination during pregnancy. Main Outcomes and Measures: Childhood outcomes studied were immune-related (eg, asthma, infections), non-immune-related (eg, neoplasms, sensory impairment), and nonspecific (eg, urgent or inpatient health care utilization), measured from emergency department and hospitalization databases. Results: Among 28 255 children (49% female, 92% born at ≥37 weeks' gestation), 10 227 (36.2%) were born to women who received seasonal influenza vaccination during pregnancy. During a mean follow-up of 3.6 years, there was no significant association between maternal influenza vaccination and childhood asthma (incidence rate, 3.0 vs 2.5 per 1000 person-years; difference, 0.53 per 1000 person-years [95% CI, -0.15 to 1.21]; adjusted HR, 1.22 [95% CI, 0.94 to 1.59]), neoplasms (0.32 vs 0.26 per 1000 person-years; difference, 0.06 per 1000 person-years [95% CI, -0.16 to 0.28]; adjusted HR, 1.26 [95% CI, 0.57 to 2.78]), or sensory impairment (0.80 vs 0.97 per 1000 person-years; difference, -0.17 per 1000 person-years [95% CI, -0.54 to 0.21]; adjusted HR, 0.82 [95% CI, 0.49 to 1.37]). Maternal influenza vaccination in pregnancy was not significantly associated with infections in early childhood (incidence rate, 184.6 vs 179.1 per 1000 person-years; difference, 5.44 per 1000 person-years [95% CI, 0.01 to 10.9]; adjusted IRR, 1.07 [95% CI, 0.99 to 1.15]) or with urgent and inpatient health services utilization (511.7 vs 477.8 per 1000 person-years; difference, 33.9 per 1000 person-years [95% CI, 24.9 to 42.9]; adjusted IRR, 1.05 [95% CI, 0.99 to 1.16]). Conclusions and Relevance: In this population-based cohort study with mean follow-up duration of 3.6 years, maternal influenza vaccination during pregnancy was not significantly associated with an increased risk of adverse early childhood health outcomes.


Assuntos
Vacinas contra Influenza/efeitos adversos , Influenza Humana/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Vacinação/efeitos adversos , Adulto , Asma/epidemiologia , Pré-Escolar , Intervalos de Confiança , Feminino , Seguimentos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Infecções/epidemiologia , Vacinas contra Influenza/administração & dosagem , Nascido Vivo/epidemiologia , Masculino , Idade Materna , Neoplasias/epidemiologia , Nova Escócia/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Estações do Ano , Transtornos das Sensações/epidemiologia , Vacinação/estatística & dados numéricos , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-33946397

RESUMO

This study aimed to identify differences in the trends of artificial and spontaneous fetal mortality rates between working and jobless households depending on ages, periods, and birth cohorts in Japan. Vital Statistics data from 1995 to 2019 and age groups in 5-year increments from 15 to 19 years through 45 to 49 years were used. Bayesian age-period-cohort analysis was used to evaluate changes in each of the outcomes. As a result, the difference in maternal age-standardized rate of both the artificial and spontaneous fetal mortality rates between the two types of households decreased in the periods analyzed. However, there was a statistically significant difference in the mortality rate between jobless and working households, regardless of maternal ages, periods, and cohorts for the artificial fetal mortality rate. A statistically significant difference was also observed for the spontaneous fetal mortality rates in some maternal ages, periods, and cohorts. In addition, the trend of birth cohort effects was particularly different between the two types of households for both the artificial and spontaneous fetal mortality rates.


Assuntos
Mortalidade Fetal , Mortalidade , Teorema de Bayes , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Idade Materna , Gravidez
20.
Biomed Res Int ; 2021: 2732983, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33969116

RESUMO

Objectives: To compare the differences of epidemiology analysis in population birth defects (BDs) between the rural and urban areas of Hunan Province in China. Methods: The data of population-based BDs in Liuyang county (rural) and Shifeng district (urban) in Hunan Province for 2014-2018 were analyzed. BD prevalence rates, percentage change, and annual percentage change (APC) by sex and age were calculated to evaluate time trends. Risk factors associated with BDs were assessed using simple and multiple logistic regression analyses. Results: The BD prevalence rate per 10,000 perinatal infants (PIs) was 220.54 (95% CI: 211.26-230.13) in Liuyang and 181.14 (95% CI: 161.18-202.87) in Shifeng. Significant decreasing trends in BD prevalence rates were noted in the female PIs (APC = -9.31, P = 0.044) and the total BD prevalence rate in Shifeng (APC = -14.14, P = 0.039). Risk factors for BDs were as follows: rural area, male PIs, PIs with gestational age < 37 weeks, PIs with birth weight < 2500 g, and migrant pregnancies. Conclusions: We should focus on rural areas, reduce the prevalence of premature and low birth weight infants, and provide maternal healthcare services for migrant pregnancies for BD prevention from the perspective of population-based BD surveillance.


Assuntos
Anormalidades Congênitas/epidemiologia , População Rural , População Urbana , Adulto , China/epidemiologia , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Idade Materna , Prevalência , Adulto Jovem
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