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1.
Sci Rep ; 12(1): 12415, 2022 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-35858984

RESUMO

Gestation increases the biomechanical loading of lower extremities. Gestational loading may influence anthropometrics of articular surfaces in similar means as bone diaphyseal properties. This study aimed to investigate whether gravidity (i.e. number of pregnancies) and parity (i.e. number of deliveries) is associated with knee breadth among middle-aged women. The study sample comprised 815 women from the Northern Finland Birth Cohort 1966. The median parity count of our sample was 2 and the median gravidity count 3. At the age of 46, questionnaires were used to enquire gravidity and parity, and posteroanterior knee radiographs were used to obtain two knee breadth parameters (tibial plateau mediolateral breadth (TPML) and femoral condylar mediolateral breadth (FCML)) as representatives of articular size. The associations of gravidity and parity with knee breadth were analyzed using general linear models with adjustments for height, weight, leisure-time physical activity, smoking, and education years. Individuals with osteoarthritic changes were excluded from our sample. The mean TPML in our sample was 70.3 mm and the mean FCML 71.6 mm respectively. In the fully adjusted models, gravidity and parity showed positive associations with knee breadth. Each pregnancy was associated with 0.11-0.14% larger knee breath (p < 0.05), and each delivery accounted for an increase of 0.20% in knee breadth (p < 0.01). Between-group comparisons showed that multiparous women had 0.68-1.01% larger knee breath than nulli- and primiparous women (p < 0.05). Pregnancies and deliveries seem to increase the mediolateral breadth of the knee. This increase is potentially associated with increased biomechanical loadings during gestation.


Assuntos
Número de Gestações , Joelho , Estudos de Coortes , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Paridade , Gravidez
2.
Neurourol Urodyn ; 41(6): 1505-1510, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35731180

RESUMO

AIMS: This study aimed to determine the impact of pregnancy and pregnancy-associated characteristics on nocturia. METHODS: Using the National Health and Nutrition Examination Survey (NHANES) database from 2005/06 to 2017/18, we analyzed women who completed the "Reproductive Health" and "Kidney Conditions-Urology" questionnaires by sorting them into three groups: nulligravida, previously pregnant (nonpregnant with prior pregnancies), and currently pregnant. After excluding patients with pre-existing conditions impacting nocturia or with incomplete data, we weighed and matched the groups for age, race, BMI, and number of pregnancies. The relationships of nocturia to pregnancy in all groups and pregnancy-associated characteristics (gestational diabetes mellitus [GDM], history of multiple pregnancies, and trimesters of pregnancy) in currently pregnant women were assessed. RESULTS: Of 8330 women that indicated pregnancy status, 1544 women (age range: 20-44 years; 523 nulligravida, 498 previously pregnant, 523 currently pregnant women) were included in analysis. Currently, pregnant women had a higher prevalence of nocturia than previously pregnant and nulligravida women (56.4% vs. 22.5% vs. 16.1%, p < 0.001) and had the highest odds of nocturia (OR: 6.82, p < 0.001). GDM or history of multiple pregnancies showed no associations in currently pregnant women. Increasing trimesters were associated with nocturia, with the third trimester showing the highest odds (OR: 10.35, p < 0.001) and a greater average of nighttime voids than the first and second trimesters (2.40 ± 1.42 vs. 1.56 ± 1.31 and 1.88 ± 1.32, p < 0.001). CONCLUSIONS: The association noted between pregnancy and nocturia, which strengthened with increasing trimesters, demonstrates that nocturia can significantly impact quality of life and therefore must be addressed during pregnancy.


Assuntos
Diabetes Gestacional , Noctúria , Adulto , Feminino , Número de Gestações , Humanos , Noctúria/epidemiologia , Inquéritos Nutricionais , Gravidez , Qualidade de Vida , Adulto Jovem
3.
Rev Esc Enferm USP ; 56: e20220040, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35730717

RESUMO

OBJECTIVE: To analyze the influence of an educational technology on the knowledge of primigravidae about the signs of labor and obstetric risk. METHOD: A quasi-experimental, before-and-after, non-randomized and non-concurrent study carried out with 90 primigravidae. For data analysis, descriptive statistics was applied,McNemarandStudent's t test. The project was submitted and approved by the Research Ethics Committee in 2020. RESULTS: The profile of the pregnant women corresponded to women with an average age of 23 years, brown, living in a common-law marriage, and with an average of 10 years of education. Half of the pregnant women were in the third trimester of pregnancy and were undergoing usual-risk prenatal care. Only 12.22% of the participants reported having access to information on the subject. Data analysis showed a significant difference in the number of correct answers for the questions, before and after viewing the animated video, especially in questions related to signs of labor, bag of waters, and fetal movement test. CONCLUSION: Educational technology has a positive influence on primigravidae's knowledge about signs of labor and obstetric risk.


Assuntos
Número de Gestações , Trabalho de Parto , Adulto , Tecnologia Educacional , Feminino , Humanos , Gravidez , Gestantes , Cuidado Pré-Natal , Adulto Jovem
4.
Malar J ; 21(1): 110, 2022 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-35361195

RESUMO

BACKGROUND: Malaria in Mali remains a primary cause of morbidity and mortality, with women at high risk during pregnancy for placental malaria (PM). Risk for PM and its association with birth outcomes was evaluated in a rural to urban longitudinal cohort on the Bandiagara Escarpment and the District of Bamako. METHODS: Placental samples (N = 317) were collected from 249 mothers who were participants in a prospective cohort study directed by BIS in the years 2011 to 2019. A placental pathologist and research assistant evaluated the samples by histology in blinded fashion to assess PM infection stage and parasite density. Generalized estimating equations (GEE) were used to model the odds of PM infection. RESULTS: In a multivariable model, pregnancies in Bamako, beyond secondary education, births in the rainy season (instead of the hot dry season), and births to women who had ≥ 3 doses of sulfadoxine-pyrimethamine (SP) instead of no doses were associated with reduced odds of experiencing PM (active and past infections combined). Births in later years of the study were strongly associated with reduced odds of PM. Maternal age, which was positively associated with offspring year of birth, was significant as a predictor of PM only if offspring year of birth was omitted from the model. Gravidity was positively associated with both maternal age and offspring year of birth such that if either variable was included in the model, then gravidity was no longer significant. However, if maternal age or year of offspring birth were not adjusted for, then the odds of PM were nearly two-fold higher in primigravida compared to multigravida. Birth outcomes improved (+ 285 g birth weight, + 2 cm birth length, + 75 g placental weight) for women who had ≥ 3 doses of SP compared to no doses, but no difference was detected in birth weight or length for women who had 2 instead of ≥ 3 SP doses. However, at 2 instead of ≥ 3 doses placentas were 36 g lighter and the odds of low birth weight (< 2500 g) were 14% higher. Severe parasite densities (> 10% erythrocytes infected) were significantly associated with decreases in birth weight, birth length, and placental weight, as were chronic PM infections. The women who received no SP during pregnancy (7% of the study total) were younger and lacked primary school education. The women who received ≥ 3 doses of SP came from more affluent families. CONCLUSIONS: Women who received no doses of SP during pregnancy experienced the most disadvantageous birth outcomes in both Bamako and on the Bandiagara Escarpment. Such women tended to be younger and to have had no primary school education. Targeting such women for antenatal care, which is the setting in which SP is most commonly administered in Mali, will have a more positive impact on public health than focusing on the increment from two to three doses of SP, although that increment is also desirable.


Assuntos
Malária , Placenta , Estudos de Coortes , Combinação de Medicamentos , Feminino , Número de Gestações , Humanos , Malária/epidemiologia , Malária/prevenção & controle , Mali/epidemiologia , Placenta/parasitologia , Gravidez , Estudos Prospectivos , Pirimetamina , Fatores de Risco , Sulfadoxina
5.
BMC Pregnancy Childbirth ; 22(1): 248, 2022 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-35331181

RESUMO

BACKGROUND: Malaria in pregnancy can result in placental infection with fetal implications. This study aimed at assessing placental malaria (PM) prevalence and its associated factors in a cohort of pregnant women with peripheral malaria and their offspring. METHOD: The data were collected in the framework of a clinical trial on treatments for malaria in pregnant women . Placental malaria (PM) was diagnosed by histopathological detection of parasites and/or malaria pigment on placenta biopsies taken at delivery. Factors associated with PM were assessed using logistic regression. RESULTS: Out of 745 biopsies examined, PM was diagnosed in 86.8 % of women. Acute, chronic and past PM were retrieved in 11 (1.5 %), 170 (22.8 %), and 466 (62.6 %) women, respectively. A modifying effect was observed in the association of gravidity or anemia at the study start with pooled PM (presence of parasites and/or malaria pigment). In women under 30, gravidity ≤ 2 was associated with an increased prevalence of pooled PM but in women aged 30 years or more, gravidity was no more associated with pooled PM (OR 6.81, 95 % CI 3.18 - 14.60; and OR 0.52, 95 % CI 0.10 - 2.76, respectively). Anemia was associated with pooled PM in women under 30 (OR 1.96, 95 % CI 1.03 - 3.72) but not in women aged 30 years or more (OR 0.68, 95 % CI 0.31 - 1.49). Similarly, the association of gravidity with past-chronic PM depended also on age. A higher prevalence of active PM was observed in women under 30 presenting with symptomatic malaria (OR 3.79, 95 % CI 1.55 - 9.27), while there was no significant increase in the prevalence of active PM (presence of parasites only) in women with symptomatic malaria when aged 30 years or more (OR 0.42, 95 % CI 0.10 - 1.75). In women with chronic PM, the prevalence of low birth weight or prematurity was the highest (31.2 %) as compared with past PM or no PM. CONCLUSION: Despite the rapid diagnosis and efficacious treatment of peripheral infection, the prevalence of placental malaria remained high in women with P. falciparum peripheral infection in Nanoro, especially in younger women This underlines the importance of preventive measures in this specific group.


Assuntos
Malária Falciparum , Malária , Adulto , Burkina Faso/epidemiologia , Feminino , Número de Gestações , Humanos , Malária/epidemiologia , Malária Falciparum/parasitologia , Placenta/parasitologia , Gravidez
6.
Asian Pac J Cancer Prev ; 23(2): 665-671, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35225480

RESUMO

OBJECTIVES: Breast surgery requires a high aesthetic outcome and should be individualized according to anthropometric breast and body characteristics. This study aimed to measure the anthropometric parameters and volume of Vietnamese female breasts and their application in breast surgery. SUBJECTS AND METHODS: A cross-sectional descriptive study enrolled 240 women treated at Vietnam National Cancer Hospital aged 18 to 78 years old. The measurements were obtained with the patient sitting upright in the anatomic position based on key landmarks and breast volume was also assessed. Differences in breast anthropometric measurements and breast volume were compared between groups of age, BMI, and the number of children. The correlation between breast volume calculated by anthropometric method and surgical specimen volume was evaluated to determine the accuracy of this method. RESULTS: The mean values of the right and left breast volumes are less statistically different. Mean breast volume of the right breast and left breast were 396.1±182.3ml and 399.4±182.2ml, respectively. The proportion of breast ptosis increased with age (p=0.027), Body mass index (p<0.0001), and the number of children (p=0.004). The most important factor affecting the size and shape of the breast was body mass index (BMI). Mastectomy specimen volume and breast volume calculated by the anthropometric method are highly correlated with r=0.966. CONCLUSIONS: The results of this study should be applied in clinical practice in breast surgery for Vietnamese women.
.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Pontos de Referência Anatômicos/cirurgia , Antropometria/métodos , Mama/anatomia & histologia , Mama/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Asiáticos/estatística & dados numéricos , Índice de Massa Corporal , Estudos Transversais , Feminino , Número de Gestações , Humanos , Mastectomia , Pessoa de Meia-Idade , Tamanho do Órgão , Gravidez , Postura Sentada , Vietnã , Adulto Jovem
7.
Asian Pac J Cancer Prev ; 23(1): 13-24, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35092367

RESUMO

BACKGROUNDS: Early menstruation, late menopause, no pregnancy, and genetic factors are known risk factors of the disease, but their effects may differ in Asian and Caucasian women. The purpose of this study was to identify genetic variants of genes related to estrogen signaling in a large city hospital-based cohort and to determine their interactions with lifestyles. METHODS: This is a case-control study. Three hundred ninety participants diagnosed with breast cancer were compared with 36,290 controls(no cancer)to explore the genetic variants to influence breast cancer risk. Based on GWAS results, the selected genetic variants were subjected to their interactions by generalized multifactor dimensionality reduction (GMDR) analysis. RESULTS: Early menstruation(OR=1.55), early menopause (OR=1.70), and no experience of pregnancy(OR=2.86) had a positive association with breast cancer risk(P<0.05). The selected polygenetic risk score(PRS) models included four SNPs and seven SNPs: The four-SNP PRS model included CDH13_rs12600325, SMYD3_rs3753686, FGF12_rs2134635, and ESRRB_rs10873289, and in the seven-SNP PRS model, ESR1_ rs2046210, estrogen-related receptor gamma(ESRRG)_rs17043393, and EGFR_ rs6958497 were added into the four-SNP PRS model. Early menstruation, early menopause, and no pregnancy experience interacted with four-SNP PRS. For the participants who had early menstruation and early menopause, high-PRS had an association with a much higher breast cancer risk than the low-PRS in the four-SNP model. However, metabolic parameters, nutrient intakes, and different dietary patterns did not interact with PRS for breast cancer risk. However, alcohol intake interacted with PRS for breast cancer risk (OR=2.33 and 8.07 for mild and moderate alcohol consumption, respectively; P=0.0004). CONCLUSION: Consideration of age at menarche and menopause, pregnancy experience, and alcohol intake may be required to reduce breast cancer risk in women with a high-PRS of genes related to the estrogen signaling pathway.


Assuntos
Consumo de Bebidas Alcoólicas/genética , Neoplasias da Mama/genética , Número de Gestações/genética , Menarca/genética , Menopausa/genética , Receptores de Estrogênio/genética , Asiáticos/genética , Caderinas/genética , Estudos de Casos e Controles , Receptores ErbB/genética , Receptor alfa de Estrogênio/genética , Feminino , Fatores de Crescimento de Fibroblastos/genética , Predisposição Genética para Doença/genética , Estudo de Associação Genômica Ampla , Histona-Lisina N-Metiltransferase/genética , Humanos , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Gravidez , Fatores de Risco , Brancos/genética
8.
BMJ Case Rep ; 15(1)2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-35058284

RESUMO

Pregnancy with complete heart block is rare, its management is not streamlined and requires a multidisciplinary team approach involving the obstetrician, cardiologist, anaesthesiologist and neonatologist. High index of suspicion in a woman with slow heart rate and electrocardiographic examination will ensure the diagnosis of this condition. Such patient can be managed conservatively or may require temporary or permanent pacemaker implantation. We present a 26-year-old primigravida with complete heart block at term pregnancy. She was asymptomatic throughout her pregnancy with pulse rate between 50 and 60 beats per minute. Vaginal delivery was planned under continuous ECG monitoring. Isoprenaline drip and temporary pacemaker were kept stand-by. However, for obstetric reasons caesarean section was performed successfully under spinal anaesthesia without a pacemaker. Method of anaesthesia was planned to keep the haemodynamics stable and drugs causing bradycardia were avoided.


Assuntos
Raquianestesia , Bloqueio Atrioventricular , Marca-Passo Artificial , Adulto , Bloqueio Atrioventricular/terapia , Cesárea , Feminino , Número de Gestações , Humanos , Gravidez
9.
J Obstet Gynaecol ; 42(1): 23-27, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33892614

RESUMO

This randomised controlled trial aimed to compare the effect of early and delayed pushing during the second stage of labour in women with occipitoposterior (OP) malposition. It included 184 nulliparous women with OP position randomised to early pushing in which women were allowed to push within one hour after full cervical dilatation or delayed pushing in which women were asked not to push for maximum of three hours or start pushing when the vertex was visible. The primary outcome was successful vaginal delivery. The rate of spontaneous vaginal delivery was significantly higher in the early pushing group (80.4 vs. 60.9%, p=.004) while the rate of instrumental vaginal delivery (30.4 vs. 15.4%) and CS (8.7 vs. 4.3%) was significantly higher in the delayed pushing group. Women in the delayed pushing group showed a significantly longer duration of the second stage (129.4 ± 7.5 vs. 61.6 ± 15.3 minutes, p<.001) and shorter duration of pushing (219.8 ± 74.8 vs. 693.9 ± 145.2 seconds, p<.001) .The rate of 2nd and 3rd degree perineal lacerations (19.6 and 13% vs. 5.4 and 8.7% respectively, p=.013) and vaginal tears (41.3 vs. 8.7%, p<.001) was significantly higher in the early pushing group. We concluded that early pushing during the second stage of labour is associated with higher rates of spontaneous vaginal delivery and vaginal and perineal lacerations.Clinical trial registration NCT03121274.Impact StatementWhat is already known on this subject? Occipitoposterior malposition is common during delivery especially in primigravida and is associated with higher rates of instrumental delivery and caesarean section. It can be managed through early or delayed pushing.What the results of this study add? Early pushing is associated with higher rates of spontaneous vaginal delivery, perineal and vaginal tears, shorter duration of second stage of labour, shorter duration of pushing, lower rates of both instrumental vaginal delivery and caesarean section.What the implications are of these findings for clinical practice and/or further research? Early pushing during the second stage of labour is associated with higher rates of spontaneous vaginal delivery and vaginal and perineal lacerations in women with OP malposition and should be tried and not delaying the pushing.


Assuntos
Anestesia Epidural , Parto Obstétrico/estatística & dados numéricos , Apresentação no Trabalho de Parto , Segunda Fase do Trabalho de Parto/fisiologia , Complicações do Trabalho de Parto/fisiopatologia , Adulto , Parto Obstétrico/métodos , Feminino , Número de Gestações , Humanos , Primeira Fase do Trabalho de Parto , Lacerações/etiologia , Complicações do Trabalho de Parto/etiologia , Períneo/lesões , Gravidez , Fatores de Tempo
10.
Nurs Open ; 9(2): 1210-1217, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34951142

RESUMO

AIM: This study aimed to assess the timely initiation of Antenatal Care and associated factors among pregnant women attending antenatal care clinics at Bahir Dar city, North West Ethiopia. DESIGN: Institutional based cross-sectional study was conducted. METHODS: Data were collected on 804 pregnant women from 20 February to 27 March 2017. Face-to-face interview through systematic sampling technique was applied. Binary logistic regression was performed using SPSS software version 21, and the level of significance of association was determined at p-value <0.05 with a 95%confidence interval. RESULTS: This study identified 44.2% of pregnant women started their first antenatal care timely. Maternal secondary and above level of education AOR = 7.07 (95% CI: 4.41, 11.35)), age at first pregnancy >18 years AOR = 2.77 (95% CI: 1.39, 5.57) and having information about the correct time of ANC booking AOR = 3.14 (95% CI: 1.67, 5.92) were significantly associated with timely commencement to first antenatal care.


Assuntos
Gestantes , Cuidado Pré-Natal , Estudos Transversais , Etiópia , Feminino , Número de Gestações , Humanos , Gravidez , Inquéritos e Questionários
11.
PLoS One ; 16(12): e0260691, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34855843

RESUMO

BACKGROUND: Depression is a common mental disorder. The burden of antenatal depression is higher in developing countries which is 20% as compared to developed ones 10% to 15%. In Ethiopia around one-fifth of pregnant mothers are depressed. Despite the severity of the problem, only a few studies have been done in Ethiopia, and there is no study done in Arba Minch on the problem. OBJECTIVE: To assess the magnitude and associated factors of antenatal depressive symptoms among pregnant women attending Public Health facilities in Arba Minch town Southern Nations and Nationalities Peoples Region, Ethiopia 2018. METHODS: Health Institution based, cross-sectional study design was used to assess the magnitude and associated factors of antenatal depression among 323 pregnant mothers who came for antenatal care follow-up in all public health facilities in Arba Minch town. The systematic random sampling technique was applied. Interviewer administered, pretested structured Questionnaire containing Edinburgh postpartum depression scale was utilized. EPI INFO was used to enter data and then the data were analyzed by logistic regression using SPSS. Variables with P-value less than 0.2 in the bivariate logistic regression were inserted in for multivariable analysis to see their independent effect and those with P-value less than 0.05 were used to determine the significant association between dependent and independent variables. RESULT: The magnitude of antenatal depression was 35.4%. Variables that were significantly associated with antenatal depression on multivariate analysis were anxiety (AOR = 5.49, 95%CI: 2.56, 11.77), un-planned pregnancy (AOR = 2.71, 95%CI: 1.21, 6.07), and Primigravida (AOR = 2.96, 95%CI: 1.28, 6.8). Similarly, uneducated mothers and those who attend only elementary school had AOR 4.92, 95% CI 1.36,17.73 and AOR 4.04955CI 1.23, 13.39 respectively. CONCLUSION: The magnitude of antenatal depression, intimate partner violence, and threatening life event in Arba Minch town was high. Anxiety, unplanned pregnancy, educational status, and Primigravida were significantly associated factors with depression. There should be a mechanism for routine screening and management of antenatal depression and intimate partner violence during antenatal care follow-up.


Assuntos
Ansiedade/complicações , Depressão/patologia , Gravidez não Planejada/psicologia , Adolescente , Adulto , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Escolaridade , Etiópia/epidemiologia , Feminino , Número de Gestações , Instalações de Saúde , Humanos , Entrevistas como Assunto , Violência por Parceiro Íntimo , Modelos Logísticos , Gravidez , Cuidado Pré-Natal , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
12.
J Therm Biol ; 102: 103115, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34863479

RESUMO

Sprint speed is a major performance trait in animal fitness involved in escaping from predators, obtaining food, and defending territory. Biotic and abiotic factors may influence sprint speed in lizards. Temperature decreases at higher altitude. Therefore, lizards at high elevations may require longer basking times to reach optimal body temperatures, increasing their vulnerability to predation and decreasing their time for other activities such as foraging or reproduction. Here, we tested whether the maximum sprint speed of a lizard that shows conservative thermal ecology varied along an altitudinal gradient comprising low (2500 m), middle (3400 m) and high-altitude (4300 m) populations. We also tested whether sprint speed was related to dorsal reflectance at different ecologically relevant temperatures. Given that the lizard Sceloporus grammicus shows conservative thermal ecology with altitude, we expected that overall average sprint speed would not vary with altitude. However, given that darker lizards heat up quicker, we expected that darker lizards would be faster than lighter lizards. Our results suggest that S. grammicus at high altitude are faster and darker at 30 °C, while lizards from low and middle altitude are faster and lighter in color at 20 °C than high altitude lizards. Also, our results suggest a positive relationship between sprint speed and dorsal skin reflectance at 10 and 20 °C. Sprint speed was also affected by snout-vent length, leg length, and leg thickness at 10 °C. These results suggest that, even though predation pressure is lower at extreme altitudes, other factors such as vegetation cover or foraging mode have influenced sprint speed.


Assuntos
Altitude , Lagartos/fisiologia , Corrida/fisiologia , Animais , Temperatura Corporal/fisiologia , Regulação da Temperatura Corporal/fisiologia , Temperatura Baixa , Ecologia , Ecossistema , Feminino , Número de Gestações , Masculino , Atividade Motora/fisiologia , Reprodução/fisiologia , Caracteres Sexuais
13.
Biomed Res Int ; 2021: 2754407, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34917681

RESUMO

BACKGROUND: Malaria is one of the leading causes of morbidity and mortality especially in pregnant women and under-five-year-old children. However, data on the prevalence among delivering mothers, potential fetal transmission, and associated birth outcomes is lacking in Ethiopia. OBJECTIVE: To assess the prevalence of Plasmodium infection from peripheral, placental, and cord blood samples among delivering mothers in Kuch health center, Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted among 218 delivering mothers from February to May 2021 in Kuch health center. Data on sociodemographic characteristics and clinical and obstetric history of mothers were collected using a structured questionnaire. Giemsa stained blood films from maternal capillary and placental and umbilical cord blood were examined for plasmodium infection. Data were analyzed using Statistical Package for the Social Sciences version 23 software package. RESULTS: The prevalence of maternal, placental, and umbilical cord malaria was 6.4% (14/218), 2.3% (5/218), and 0.5% (1/218), respectively. Plasmodium falciparum and Plasmodium vivax accounted 3.7% (8/218) and 2.8% (6/218), respectively, in maternal peripheral blood but only Plasmodium falciparum was detected in placental and umbilical cord blood samples. Maternal malaria had significant association with primigravida (χ 2 = 12.611, p = 0.002) and low birth weight (χ 2 = 8.381, p = 0.004). Placental malaria was also significantly associated with low birth weight (χ 2 = 32.255, p ≤ 0.001). CONCLUSION: The prevalence of malaria among delivering mothers was considerable. Maternal peripheral malaria had a significant association with gravidity and birth weight. Placental and umbilical cord malaria also had a significant association with birth weight. Pregnant mothers should be examined for malaria and receive appropriate treatment to prevent adverse birth outcomes.


Assuntos
Malária/epidemiologia , Mães/estatística & dados numéricos , Adulto , Peso ao Nascer/fisiologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Sangue Fetal/parasitologia , Feto/parasitologia , Número de Gestações/fisiologia , Instalações de Saúde/estatística & dados numéricos , Humanos , Placenta/parasitologia , Plasmodium falciparum/patogenicidade , Plasmodium vivax/patogenicidade , Gravidez , Complicações na Gravidez/parasitologia , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Cordão Umbilical/parasitologia , Adulto Jovem
14.
PLoS One ; 16(11): e0260134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34793557

RESUMO

Maternal smoking is established to cause adverse birth outcomes, but evidence considering maternal smoking change across successive pregnancies is sparse. We examined the association between self-reported maternal smoking during and between the first two pregnancies with the odds of small for gestational age (SGA) birth (<10th percentile) in the second infant. Records for the first two pregnancies for 16791 women within the SLOPE (Studying Lifecourse Obesity PrEdictors) study were analysed. This is a population-based cohort of prospectively collected anonymised antenatal and birth healthcare data (2003-2018) in Hampshire, UK. Logistic regression was used to relate maternal smoking change to the odds of SGA birth in the second infant. In the full sample, compared to never smokers, mothers smoking at the start of the first pregnancy had higher odds of SGA birth in the second pregnancy even where they stopped smoking before the first antenatal appointment for the second pregnancy (adjusted odds ratio (aOR) 1.50 [95% confidence interval 1.10, 2.03]). If a mother was not a smoker at the first antenatal appointment for either her first or her second pregnancy, but smoked later in her first pregnancy or between pregnancies, there was no evidence of increased risk of SGA birth in the second pregnancy compared to never smokers. A mother who smoked ten or more cigarettes a day at the start of both of her first two pregnancies had the highest odds of SGA birth (3.54 [2.55, 4.92]). Women who were not smoking at the start of the first pregnancy but who subsequently resumed/began smoking and smoked at the start of their second pregnancy, also had higher odds (2.11 [1.51, 2.95]) than never smokers. Smoking in the first pregnancy was associated with SGA birth in the second pregnancy, even if the mother quit by the confirmation of her second pregnancy.


Assuntos
Retardo do Crescimento Fetal/induzido quimicamente , Fumar Tabaco/efeitos adversos , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Idade Gestacional , Número de Gestações/efeitos dos fármacos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Modelos Logísticos , Comportamento Materno , Parto , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Fatores de Tempo
15.
PLoS One ; 16(11): e0260101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34843537

RESUMO

OBJECTIVE: This study aimed to review the reasons why postpartum women present to the emergency department (ED) over a short term (≤10 days post-delivery) and to identify the risk factors associated with early visits to the ED. METHODS: This retrospective chart review included all women who delivered at a regional health system (William Osler Health System, WOHS) in 2018 and presented to the WOHS ED within 10 days after delivery. Baseline descriptive statistics were used to examine the patient demographics and identify the timing of the postpartum visit. Univariate tests were used to identify significant predictors for admission. A multivariate model was developed based on backward selection from these significant factors to identify admission predictors. RESULTS: There were 381 visits identified, and the average age of the patients was 31.22 years (SD: 4.83), with median gravidity of 2 (IQR: 1-3). Most patients delivered via spontaneous vaginal delivery (53.0%). The median time of presentation to the ED was 5.0 days, with the following most common reasons: abdominal pain (21.5%), wound-related issues (12.6%), and urinary issues (9.7%). Delivery during the weekend (OR 1.91, 95% CI 1.00-3.65, P = 0.05) was predictive of admission while Group B Streptococcus positive patients were less likely to be admitted (OR 0.22, CI 0.05-0.97, P<0.05). CONCLUSIONS: This was the first study in a busy community setting that examined ED visits over a short postpartum period. Patient education on pain management and wound care can reduce the rate of early postpartum ED visits.


Assuntos
Serviços Médicos de Emergência/tendências , Complicações do Trabalho de Parto/etiologia , Adulto , Canadá , Causalidade , Parto Obstétrico/tendências , Serviço Hospitalar de Emergência/tendências , Feminino , Número de Gestações , Hospitalização , Humanos , Complicações do Trabalho de Parto/epidemiologia , Manejo da Dor , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Período Pós-Parto , Gravidez , Fatores de Risco , Cicatrização
16.
BMC Pregnancy Childbirth ; 21(1): 756, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749679

RESUMO

BACKGROUND: Although the use of prenatal ultrasound services has increased in low- income and lower middle-income countries, there has not been a concurrent improvement in perinatal mortality. It remains unknown whether individual ultrasound findings in this setting are associated with neonatal death or the need for resuscitation at delivery. If associations are identified by ultrasound, they could be used to inform the birth attendant and counsel the family regarding risk, potentially altering delivery preparedness in order to reduce neonatal mortality. METHODS: This was a secondary analysis of data collected from a prospective cohort. Data was gathered at Nawanyago Health Centre III in Kamuli District, Uganda. Participants included pregnant women who received second and third trimester prenatal ultrasound scans and delivered at that center between July 2010 and August 2018. All ultrasounds were performed at Nawanyago and deliveries were attended solely by midwives or nurses. Predictor variables included the following ultrasound findings: fetal number, fetal presentation, and amniotic fluid volume. The primary outcome was bag-mask ventilation (BMV) of the neonate at delivery. The secondary outcome was stillbirth or neonatal death in the delivery room. RESULTS: Primary outcome data was available for 1105 infants and secondary outcome data was available for 1098 infants. A total of 33 infants received BMV at delivery. The odds of receiving BMV at delivery was significantly increased if amniotic fluid volume was abnormal (OR 4.2, CI 1.2-14.9) and there were increased odds for multiple gestation (OR 1.9, CI 0.7-5.4) and for non-vertex fetal presentation (OR 1.4, CI 0.6-3.2) that were not statistically significant. Stillbirth or neonatal death in the delivery room was diagnosed for 20 infants. Multiple gestation (OR 4.7, CI 1.6-14.2) and abnormal amniotic fluid volume (OR 4.8, CI 1.0-22.1) increased the odds of stillbirth or neonatal death in the delivery room, though only multiple gestation was statistically significant. CONCLUSION: Common findings that are easily identifiable on ultrasound in low- and lower middle-income countries are associated with adverse perinatal outcomes. Education could lead to improved delivery preparedness, with the potential to reduce perinatal mortality. This was a preliminary study; larger prospective studies are needed to confirm these findings.


Assuntos
Morte Perinatal , Resultado da Gravidez/epidemiologia , Respiração Artificial/estatística & dados numéricos , Natimorto/epidemiologia , Ultrassonografia Pré-Natal , Adulto , Líquido Amniótico , Índice de Apgar , Feminino , Feto/diagnóstico por imagem , Número de Gestações , Humanos , Recém-Nascido , Apresentação no Trabalho de Parto , Masculino , Razão de Chances , Gravidez , População Rural , Uganda/epidemiologia
17.
BMC Pregnancy Childbirth ; 21(1): 753, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749684

RESUMO

BACKGROUND: This study aims to detect the effects of increased BMI on labor outcomes in primigravida pregnant women. METHODS: A cross-sectional study involved 600 full-term singleton primigravida pregnant women who presented in the active phase of labor to the labor ward. They were divided according to BMI into three equals groups; women with normal BMI (group I), overweight women (group II), and women with class I obesity (group III). RESULTS: We found that high BMI was associated with a significantly increased risk of Caesarean section (C.S.) (13% in group I, 18% in group II and 40% in group III). Women with higher BMI and delivered vaginally had a significantly prolonged first and second stage of labor, consequently increased the need for oxytocin augmentation as well as the oxytocin dose. Regarding the maternal and fetal outcomes, there are significantly increased risks of postpartum sepsis, perineal tears, wound infection, as well as significantly increased birth weight and longer neonatal stay in the neonatal unit (NNU). CONCLUSION: Obese primigravida pregnant women were at higher risk of suboptimal outcomes. Besides, prolonged first and second stages of labor and the incidence of C.S. have also been increased.


Assuntos
Índice de Massa Corporal , Número de Gestações , Trabalho de Parto , Adulto , Estudos Transversais , Egito/epidemiologia , Feminino , Humanos , Obesidade Materna/complicações , Sobrepeso/complicações , Gravidez , Fatores de Risco
18.
Obstet Gynecol ; 138(4): 565-573, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34623068

RESUMO

OBJECTIVE: To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer. METHODS: We performed a population-based study of women aged 18-45 years with a history of stage I cervical cancer reported to the 2000-2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes. RESULTS: Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4-5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0-3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2-5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity. CONCLUSION: In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.


Assuntos
Colo do Útero/cirurgia , Conização/métodos , Preservação da Fertilidade/métodos , Resultado da Gravidez/epidemiologia , Neoplasias do Colo do Útero/cirurgia , Adolescente , Adulto , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Colo do Útero/patologia , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/epidemiologia , Número de Gestações , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Nascimento Prematuro/epidemiologia , Pontuação de Propensão , Natimorto/epidemiologia , Traquelectomia/métodos , Adulto Jovem
19.
Horm Behav ; 136: 105072, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34628291

RESUMO

Reproduction is a critical part of an animal's life history, but one which incurs significant costs to survival and future reproductive potential. These physiological consequences are likely to be influenced by context - for example, if an individual is subject to environmental stressors, physiological and behavioral changes associated with reproduction may be altered. Glucocorticoids, hormones produced as part of the physiological response to stressors, may alter how reproduction affects female physiology and behavior, and therefore the outcomes of reproductive trade-offs. Glucocorticoids prioritize immediate survival over reproduction, for example through changes in immune function, metabolic rate, and foraging, which may reduce energy expenditure or increase energy gain. However, we previously found that female eastern fence lizards (Sceloporus undulatus) experiencing elevated glucocorticoid levels during gestation were nevertheless able to maintain reproductive output and body condition. Here we investigate compensatory mechanisms by which eastern fence lizard females may maintain reproduction under experimental increases in a glucocorticoid, corticosterone (CORT). We found that, although CORT-treated females had similar immune function and behavior, they had reduced metabolic rates 3-5 days post-parturition compared to control females. Given that CORT-treated females spent a similar time basking and had equal food intake compared to control females, we suggest that the reduced metabolic rate is a mechanism by which CORT-treated females maintain their energy balance and reduce the energetic costs of gestation during periods of stress. This study suggests that physiological responses to reproduction may be context-dependent and could act to minimize costs of reproduction in situations where CORT is elevated (such as during periods of environmental stress).


Assuntos
Glucocorticoides , Lagartos , Animais , Corticosterona/metabolismo , Corticosterona/farmacologia , Feminino , Glucocorticoides/metabolismo , Glucocorticoides/farmacologia , Número de Gestações , Lagartos/fisiologia , Parto , Gravidez
20.
BMC Pregnancy Childbirth ; 21(1): 722, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706705

RESUMO

BACKGROUND: Malaria and curable sexually transmitted infections (STIs) are severe infections associated with poor pregnancy outcomes in sub-Saharan countries. These infections are responsible for low birth weight, preterm birth, and miscarriage. In Burkina Faso, many interventions recommended by the World Health Organization were implemented to control the impact of these infections. After decades of intervention, we assessed the impact of these infections on pregnancy outcomes in rural setting of Burkina Faso. METHODS: Antenatal care and delivery data of pregnant women attending health facilities in 2016 and 2017 were collected in two rural districts namely Nanoro and Yako, in Burkina Faso. Regression models with likelihood ratio test were used to assess the association between infections and pregnancy outcomes. RESULTS: During the two years, 31639 pregnant women received antenatal care. Malaria without STI, STI without malaria, and their coinfections were reported for 7359 (23.3%), 881 (2.8 %), and 388 (1.2%) women, respectively. Low birth weight, miscarriage, and stillbirth were observed in 2754 (10.5 %), 547 (2.0 %), and 373 (1.3 %) women, respectively. Our data did not show an association between low birth weight and malaria [Adjusted OR: 0.91 (0.78 - 1.07)], STIs [Adjusted OR: 0.74 (0.51 - 1.07)] and coinfection [Adjusted OR: 1.15 (0.75 - 1.78)]. Low birth weight was strongly associated with primigravidae [Adjusted OR: 3.53 (3.12 - 4.00)]. Both miscarriage and stillbirth were associated with malaria [Adjusted OR: 1.31 (1.07 - 1.59)], curable STI [Adjusted OR: 1.65 (1.06 - 2.59)], and coinfection [Adjusted OR: 2.00 (1.13 - 3.52)]. CONCLUSION: Poor pregnancy outcomes remained frequent in rural Burkina Faso. Malaria, curable STIs, and their coinfections were associated with both miscarriage and stillbirth in rural Burkina. More effort should be done to reduce the proportion of pregnancies lost associated with these curable infections by targeting interventions in primigravidae women.


Assuntos
Coinfecção , Malária/complicações , Malária/epidemiologia , Resultado da Gravidez/epidemiologia , Infecções Sexualmente Transmissíveis/complicações , Infecções Sexualmente Transmissíveis/epidemiologia , Aborto Espontâneo/epidemiologia , Adulto , Burkina Faso/epidemiologia , Feminino , Número de Gestações , Humanos , Recém-Nascido de Baixo Peso , Gravidez , Nascimento Prematuro/epidemiologia , População Rural , Natimorto/epidemiologia
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