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1.
Ann Saudi Med ; 41(5): 274-279, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618607

RESUMO

BACKGROUND: Pregnancy in women aged 35 years or above is generally considered an advanced maternal age (AMA). AMA is associated with an increased rate of maternal and neonatal complications. OBJECTIVES: Assess the effect of AMA on maternal and neonatal outcomes. DESIGN: Analytical cross-sectional study of medical records. SETTINGS: In-patient hospital tertiary care setting in Jeddah. PATIENTS AND METHODS: All women who attended antenatal care and delivered at King Abdulaziz Medical City in Jeddah in the first half of 2018 were included in the study. Outcomes for women 35 years of age or older were compared with younger women. Significant factors in a univariate analysis were entered in a multiple logistic regression model to assess the association between AMA and outcomes. MAIN OUTCOME MEASURES: Rates of maternal neonatal complications, analysis of factors associated with advanced maternal, gestational diabetes mellitus (GDM), cesarean delivery. SAMPLE SIZE: 1586 women. RESULTS: Of the 1586 women, 406 were 35 years of age or older (25.6%), and 1180 were younger than 35 years. The AMA group had a significantly higher proportion of GDM (32.0% versus 13.2%, P<.001). The adjusted odds ratio (OR) for GDM was 2.6 (95% CI 2-3.5, P<.001.) compared with younger women in the multivariate logistic regression analysis. Older women had a higher rate of cesarean delivery (43.6% versus 30.8%, P<.001). The adjusted OR for cesarean vs. vaginal delivery was 1.5 (CI 1.2-1.9, P=.002). CONCLUSION: Pregnancy in women 35 years or older was associated with an increased risk of GDM and cesarean delivery. LIMITATIONS: Cross-sectional design, small sample size, single hospital. CONFLICT OF INTEREST: None.


Assuntos
Resultado da Gravidez , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Idade Materna , Gravidez , Resultado da Gravidez/epidemiologia , Arábia Saudita/epidemiologia , Centros de Atenção Terciária
2.
Rev Saude Publica ; 55: 63, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34706039

RESUMO

OBJECTIVE: To describe feeding practices and the risk factors for the mixed breastfeeding and early weaning in the neonatal period. METHODS: Cohort study, which we collected socioeconomic, demographic, health care and feeding data from 415 mother/child binomials born in four public maternity hospitals in Natal/Brazil. They were followed-up at 48 hours, 7 and 28 days after birth. The association was established using Pearson's Chi-square test and Poisson's regression, after adjusting it to other variables. RESULTS: The prevalence of mixed breastfeeding in the first 2 days was 47,2% and early weaning in 7 and 28 days was 8,4% and 16,2% in that order. The main reasons for mixed breastfeeding and early weaning were: colostrum deficiency (33.8%), difficulty in latching/sucking (23.5%) and "little milk" (70.0%). The use of formula/milk/porridge remained associated with maternal age ≤ 20 years (RR = 0.64; 95%CI: 0.47-0.86), age 20-29 years (RR = 0,70; 95%CI: 0,57-0,87), primiparity (RR = 1.37; 95%CI: 1.11-1.60) and cesarean delivery (RR = 1.20; 95%CI: 1.00-1.45) at 2 days; absence of paternal support (RR = 4.98; 95%CI: 2.54-9.79) and pacifier use (RR = 3.21; 95%CI: 1.63-6.32) at 7 days; and only pacifier use (RR = 2.48; 95%CI: 1.53-4.02) at 28 days. CONCLUSIONS: Early weaning was associated with maternal and health care factors, thus suggesting the need to readjust good practices and educational actions to achieve the exclusive offer to the maternal breast in the neonatal period.


Assuntos
Aleitamento Materno , Adulto , Brasil/epidemiologia , Criança , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Idade Materna , Gravidez , Desmame , Adulto Jovem
3.
BMJ Open ; 11(9): e049337, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593494

RESUMO

OBJECTIVES: This study aimed at examining the association between young maternal age at first childbirth and under-5 mortality in sub-Saharan Africa (SSA). DESIGN AND SETTING: This cross-sectional study pooled nationally-representative data from the most recent Demographic and Health Surveys conducted in 30 countries in SSA from 2010 to 2019. PARTICIPANTS: 116 379 mothers of children under 5. RESULTS: The prevalence of adolescent childbirth and death in children under 5 in SSA were 57.36% (95% CI 53.73% to 60.99%) and 4.10% (95% CI 3.65% to 4.54%), respectively. Children born to mothers whose first childbirth occurred at <20 years were 11% more likely to die before the age of 5 compared with those whose mothers' first childbirth occurred at age ≥20 years (adjusted odds ratio (aOR) 1.11; 95% CI 1.05 to 1.18). In terms of the covariates, the likelihood of under-5 mortality was higher among children born to single (aOR 1.54; 95% CI 1.41 to 1.67) and cohabiting mothers (aOR 1.10; 95% CI 1.01 to 1.21) compared with married mothers. Children born to mothers who were obese were more likely to die before the age of 5 compared with those born to mothers with normal body weight (aOR 1.17; 95% CI 1.09 to 1.26). The odds of under-5 mortality were higher among children whose weight at birth was <2500 g compared with those whose weight was ≥2500 g at birth (aOR 1.83; 95% CI 1.64 to 2.03). CONCLUSIONS: The findings call for the need to enhance policies aimed at reducing under-5 mortality in SSA by reducing adolescent pregnancy and childbirth through family planning, comprehensive sexuality education, and the elimination of child marriage. Again, Since under-5 mortality among adolescent mothers is linked with their poor socio-economic status, there is the need for government and non-governmental organisations in SSA to introduce poverty alleviation programmes and improve access to both formal and informal education as a way of enhancing the socioeconomic status of adolescent mothers. Public health education, through continuous advocacy programmes should be done to encourage adolescent mothers to access antenatal care and health facility deliveries as a way of enhancing the survival status of their children. These interventions should be implemented, taking into consideration other characteristics of mothers such marital status and BMI and child's characteristics such as child's weight, which were found to be associated with high under-5 mortality.


Assuntos
Parto , Adolescente , Adulto , África ao Sul do Saara/epidemiologia , Criança , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Idade Materna , Gravidez , Fatores de Risco , Adulto Jovem
4.
BMJ Open ; 11(10): e046174, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34615673

RESUMO

OBJECTIVES: Rates of age-associated severe maternal morbidity (SMM) have increased in Canada, and an association with neighbourhood income is well established. Our aim was to examine SMM trends according to neighbourhood material deprivation quintile, and to assess whether neighbourhood deprivation effects are moderated by maternal age. DESIGN, SETTING AND PARTICIPANTS: A population-based retrospective cohort study using linked administrative databases in Ontario, Canada. We included primiparous women with a live birth or stillbirth at ≥20 weeks' gestational age. PRIMARY OUTCOME: SMM from pregnancy onset to 42 days postpartum. We calculated SMM rate differences (RD) and rate ratios (RR) by neighbourhood material deprivation quintile for each of four 4-year cohorts from 1 April 2002 to 31 March 2018. Log-binomial multivariable regression adjusted for maternal age, demographic and pregnancy-related variables. RESULTS: There were 1 048 845 primiparous births during the study period. The overall rate of SMM was 18.0 per 1000 births. SMM rates were elevated for women living in areas with high material deprivation. In the final 4-year cohort, the RD between women living in high vs low deprivation neighbourhoods was 3.91 SMM cases per 1000 births (95% CI: 2.12 to 5.70). This was higher than the difference observed during the first 4-year cohort (RD 2.09, 95% CI: 0.62 to 3.56). SMM remained associated with neighbourhood material deprivation following multivariable adjustment in the pooled sample (RR 1.16, 95% CI: 1.11 to 1.21). There was no evidence of interaction with maternal age. CONCLUSION: SMM rate increases were more pronounced for primiparous women living in neighbourhoods with high material deprivation compared with those living in low deprivation areas. This raises concerns of a widening social gap in maternal health disparities and highlights an opportunity to focus risk reduction efforts toward disadvantaged women during pregnancy and postpartum.


Assuntos
Período Pós-Parto , Estudos de Coortes , Feminino , Humanos , Idade Materna , Ontário/epidemiologia , Gravidez , Estudos Retrospectivos
5.
J Prev Med Hyg ; 62(2): E439-E446, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34604585

RESUMO

Background: Antenatal care is essential care given during pregnancy, to diagnose and treat complications that could endanger both the lives of mother and child. The risk of dying from pregnancy-related issues is often associated with a lack of access to antenatal care services. This issue is a prominent matter in developing countries such as Somaliland which has one of the highest maternal mortality rates in the world. Objective: The objective of this study is to determine the frequency and timing of antenatal care utilization and factors influencing it among reproductive-age women. Methods: A population-based cross-sectional survey is conducted among 330 randomly selected mothers who gave birth in the past two years in Borama, Somaliland. Result: Although a significant number of women utilized antenatal care in their pregnancy only 31.1% initiated the first visit within the first trimester and 48.3% received less than the recommended four visits. Fewer antenatal care visits are significantly associated with age (OR = 3.018; CI = 1.264-7.207), gravida (OR = 3.295; CI = 1.200-9.045), and gestation age (OR = 1.737; CI = 1.013-2.979). Early marriage (OR=0.495; CI = 0.252-0.973), and large family size (OR = 3.952; CI = 1.330-11.742) are associated with delay in the commencement of the first antenatal care visit. Conclusion: Young women, women with multiple pregnancies, women married at a young age, and women with a large family size have a higher probability of delaying prenatal care and having fewer visits. Based on the findings, uplifting the socioeconomic status and literacy level of women through community-based education and developing strategies that would take the determining factors into account may contribute to improved and adequate utilization of antenatal care.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Classe Social , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Idade Materna , Pessoa de Meia-Idade , Paridade , Vigilância da População , Gravidez , Fatores Socioeconômicos , Somália
6.
JAMA ; 326(12): 1178-1185, 2021 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-34581736

RESUMO

Importance: Evidence from studies investigating the association of epidural analgesia use during labor and delivery with risk of autism spectrum disorder (ASD) in offspring is conflicting. Objective: To assess the association of maternal use of epidural analgesia during labor and delivery with ASD in offspring using a large population-based data set with clinical data on ASD case status. Design, Setting, and Participants: This population-based retrospective cohort study included term singleton children born in British Columbia, Canada, between April 1, 2000, and December 31, 2014. Stillbirths and cesarean deliveries were excluded. Clinical ASD diagnostic data were obtained from the British Columbia Autism Assessment Network and the British Columbia Ministry of Education. All children were followed up until clinical diagnosis of ASD, death, or the study end date of December 31, 2016. Exposures: Use of epidural analgesia during labor and delivery. Main Outcomes and Measures: A clinical diagnosis of ASD made by pediatricians, psychiatrists, and psychologists with specialty training to assess ASD. Cox proportional hazards models were used to estimate the hazard ratio of epidural analgesia use and ASD. Models were adjusted for maternal sociodemographics; maternal conditions during pregnancy; labor, delivery, and antenatal care characteristics; infant sex; gestational age; and status of small or large for gestational age. A conditional logistic regression model matching women with 2 births or more and discordance in ASD status of the offspring also was performed. Results: Of the 388 254 children included in the cohort (49.8% female; mean gestational age, 39.2 [SD, 1.2] weeks; mean follow-up, 9.05 [SD, 4.3] years), 5192 were diagnosed with ASD (1.34%) and 111 480 (28.7%) were exposed to epidural analgesia. A diagnosis of ASD was made for 1710 children (1.53%) among the 111 480 deliveries exposed to epidural analgesia (94 157 women) vs a diagnosis of ASD in 3482 children (1.26%) among the 276 774 deliveries not exposed to epidural analgesia (192 510 women) (absolute risk difference, 0.28% [95% CI, 0.19%-0.36%]). The unadjusted hazard ratio was 1.32 (95% CI, 1.24-1.40) and the fully adjusted hazard ratio was 1.09 (95% CI, 1.00-1.15). There was no statistically significant association of epidural analgesia use during labor and delivery with ASD in the within-woman matched conditional logistic regression (839/1659 [50.6%] in the exposed group vs 1905/4587 [41.5%] in the unexposed group; fully adjusted hazard ratio, 1.07 [95% CI, 0.87-1.30]). Conclusions and Relevance: In this population-based study, maternal epidural analgesia use during labor and delivery was associated with a small increase in the risk of autism spectrum disorder in offspring that met the threshold for statistical significance. However, given the likelihood of residual confounding that may account for the results, these findings do not provide strong supporting evidence for this association.


Assuntos
Analgesia Epidural/efeitos adversos , Transtorno do Espectro Autista/etiologia , Trabalho de Parto , Exposição Materna/efeitos adversos , Transtorno do Espectro Autista/epidemiologia , Colúmbia Britânica/epidemiologia , Criança , Pré-Escolar , Fatores de Confusão Epidemiológicos , Feminino , Humanos , Incidência , Masculino , Idade Materna , Gravidez , Estudos Retrospectivos , Fatores de Risco
7.
JAMA ; 326(12): 1170-1177, 2021 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-34581738

RESUMO

Importance: A recent cohort study found that epidural analgesia during labor was associated with an increased risk of autism in offspring. Objective: To investigate if labor epidural increases the risk of autism in offspring. Design, Setting, and Participants: This nationwide retrospective cohort study identified all live-born children in Denmark between January 2006 and December 2013. Follow-up commenced at children's first birthday and ended in December 2017. Among 485 093 live-born children, 5915 were excluded because of occurrences during the first year of life including death, emigration, misregistration of birth, diagnosis of disease inherently linked to autism, or diagnosis of autism. Exposures: Administration of epidural analgesia during labor, as identified by procedure code. Main Outcomes and Measures: The main outcome of interest was incident diagnosis of autism spectrum disorder based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes in the Danish Psychiatric Central Register or National Patient Register. Hazard ratios were estimated using Cox regression, adjusted for covariates describing maternal comorbidity, sociodemographic factors, lifestyle, pregnancy, psychiatric illness, psychotropic medication, medical-seeking behavior, and family history of autism. A secondary analysis used a within-mother design including only children of mothers with both exposure and nonexposure to labor epidural analgesia in different deliveries. Results: The cohort included 479 178 children (233 405 girls [48.7%]; median maternal age at delivery, 30.9 [IQR, 27.6-34.2] years); of these, 92 900 (19.4%) were exposed to epidural analgesia during labor. Median follow-up was 7.0 years (IQR, 4.9-9.0 years), and by the end of follow-up, 6428 children (1.3%) had been diagnosed with autism. Exposed children had an autism diagnosis incidence rate of 23.1 per 10 000 person-years compared with 18.5 per 10 000 person-years in the unexposed group (crude hazard ratio, 1.29 [95% CI, 1.21-1.37]; adjusted hazard ratio, 1.05 [95% CI, 0.98-1.11]). A secondary within-mother analysis including 59 154 children (12.3%) estimated an autism diagnosis incidence rate of 20.8 per 10 000 person-years in the exposed group and 17.1 per 10 000 person-years in the unexposed group (adjusted hazard ratio, 1.05 [95% CI, 0.90-1.21]). Conclusions and Relevance: In this nationwide cohort study of Danish children, maternal exposure to epidural analgesia during labor was not significantly associated with autism spectrum disorder in offspring.


Assuntos
Analgesia Epidural/efeitos adversos , Transtorno do Espectro Autista/etiologia , Trabalho de Parto , Exposição Materna/efeitos adversos , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Masculino , Idade Materna , Gravidez , Estudos Retrospectivos , Fatores de Risco
8.
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
9.
Eur J Obstet Gynecol Reprod Biol ; 265: 169-174, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34508990

RESUMO

OBJECTIVE: It is recognised that advanced maternal age is associated with adverse pregnancy outcomes. It is less known what the psychological impact of having a pregnancy in later maternal age is. This study aimed to establish whether women having children over 50 experience challenges with regards to their mental well-being during the pregnancy and thereafter. STUDY DESIGN: 17 women delivered aged ≥ 50 at our maternity unit in a central London hospital between 2014 and 2020. Of these, one had died of metastatic ampullary carcinoma two years following delivery, one declined taking part, and two we were unable to get hold of, leaving 13 women in the study. Two validated questionnaires were used to survey the women: (i) Warwick-Edinburgh Mental Well-being Scale (WEMWBS), (ii) Parenting Daily Hassles Scale (PDHS). We analysed the questionnaire data using their individual scoring systems. RESULTS: The WEMWBS showed a median score of 60 out of a possible 70 (range: 45-70), indicating a high level of mental well-being among these women. The PDHS results indicated that reported hassles were overall low in both frequency and intensity for the mothers. CONCLUSION: Women giving birth over 50 have often experienced long, emotional and financially-burdensome journeys in order to fall pregnant, usually involving assisted reproductive techniques (ART), with multiple antenatal and delivery complications thereafter. As a result, they are extremely happy and grateful to have the child, and are often in better socioeconomic positions that can help with the stress that comes with child-caring.


Assuntos
Mães , Poder Familiar , Feminino , Humanos , Idade Materna , Saúde Mental , Pessoa de Meia-Idade , Gravidez , Inquéritos e Questionários
10.
PLoS One ; 16(9): e0257544, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34543331

RESUMO

In Gabon, the proportion of maternal deaths directly related to Primary PostPartum Haemorrhage (PPPH) is 15 to 25%, despite the different means that the World Health Organization has made available to the providers of Emergency Obstetrical and Neonatal Care (EmONC). The objective of this study was to determine the prevalence and epidemiological characteristics of Primary PostPartum Haemorrhage to improve its management and reduce the rate of maternal deaths. An analytical retrospective study involved 42,728 records, whose data were collected using a chart collection form on the basis of information contained in partograms and other patient records. Sociodemographic variables were expressed using percentage. The relationship between the etiologies of PPPH and certain characteristics of the women was established using the ORs with their 95% confidence intervals. The difference was significant if p < 0.05. The prevalence of PPPH was 1.6%. Delivery haemorrhages accounted for 65.5% of PPPH. The main factors associated with delivery haemorrhages were pauci parity and multiparity (p = 0.003 and 0.051), post-term (p = 0.042), and birth weight >4,000 g (p = 0.006). Those associated with genital tract injuries were young maternal age (p = 0.008) and multiparity (p = 0.028). The most common etiology was haemorrhage from delivery. Multiparity remains the most common risk factor and the young age of the patients. It is important to improve management through better assessment of blood loss in the primary postpartum period as well as capacity building of health providers on EmONC.


Assuntos
Hemorragia Pós-Parto/epidemiologia , Adolescente , Adulto , Peso ao Nascer , Parto Obstétrico/efeitos adversos , Feminino , Gabão/epidemiologia , Hospitais Universitários , Humanos , Idade Materna , Paridade , Hemorragia Pós-Parto/etiologia , Período Pós-Parto , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
PLoS One ; 16(9): e0257522, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34543347

RESUMO

INTRODUCTION: Diarrhea is responsible for the death of more than 90% of under-five children in low and lower-middle income countries. Regionally, South Asia and sub-Saharan Africa accounted for 88% of deaths with the same age group. Therefore, the aim of this study was to determine the prevalence and associated factors of diarrhea among children under-five years in sub-Saharan Africa. METHODS: The appended, most recent demographic and health survey datasets of 34 sub-Saharan African countries were used to determine the prevalence and associated factors of diarrhea among under-five children in the region. A total weighted sample of 330,866 under-five children were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of diarrhea among under five children in sub-Saharan Africa. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential factors included in the final model. RESULT: The overall prevalence of diarrhea in this study was 15.3% (95% CI: 15.1-15.4). Those children of mothers aged 15-24 (AOR = 1.26; 95% CI: 1.23, 1.30) and 25-34 years (AOR = 1.15; 95%CI: 1.12, 1.18), those children of mothers with no education (AOR = 1.69; 95%CI: 1.57-1.82), primary education (AOR = 1.73; 95%CI: 1.61-1.86) and secondary education (AOR = 1.49; 95%CI: 1.38-1.59) had higher odds of having diarrhea. Those children from poorest (AOR = 1.14; 95%CI: 1.10, 1.19), poorer (AOR = 1.12; 95%CI: 1.08-1.17), middle (AOR = 1.06; 95%CI: 1.02, 1.10), and richer (AOR = 1.14; 95%CI: 1.04-1.12) households had higher chance of having diarrhea compared to their counterparts. CONCLUSION: This study found that the prevalence of childhood diarrhea morbidity in sub-Saharan Africa was high. Maternal age, wealth index, maternal education, maternal occupation, age of child, time of initiation of breast feeding and time to get water source were significantly associated with diarrhea. Therefore, intervention through health education and health promotion for mothers/caretakers who are poor, less educated, and young should be designed to prevent diarrhea in the region.


Assuntos
Diarreia/epidemiologia , África Austral/epidemiologia , Aleitamento Materno , Pré-Escolar , Diarreia/diagnóstico , Escolaridade , Características da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Idade Materna , Razão de Chances , Prevalência , Fatores Socioeconômicos
12.
PLoS One ; 16(9): e0257722, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34555090

RESUMO

BACKGROUND: Maternal body mass index (BMI) below or above the reference interval (18.5-24.9 kg/m2) is associated with adverse pregnancy outcomes. Whether BMI exerts an effect within the reference interval is unclear. Therefore, we assessed the association between adverse pregnancy outcomes and BMI, in particular within the reference interval, in a general unselected pregnant population. METHODS: Data was extracted from a prospective population-based multicentre cohort (Risk Estimation for PrEgnancy Complications to provide Tailored care (RESPECT) study) conducted between December 2012 to January 2014. BMI was studied in categories (I: <18.5, II: 18.5-19.9, III: 20.0-22.9, IV: 23.0-24.9, V: 25.0-27.4, VI: 27.5-29.9, VII: >30.0 kg/m2) and as a continuous variable within the reference interval. Adverse pregnancy outcomes were defined as composite endpoints for maternal, neonatal or any pregnancy complication, and for adverse pregnancy outcomes individually. Linear trends were assessed using linear-by-linear association analysis and (adjusted) relative risks by regression analysis. RESULTS: The median BMI of the 3671 included women was 23.2 kg/m2 (IQR 21.1-26.2). Adverse pregnancy outcomes were reported in 1256 (34.2%). Linear associations were observed between BMI categories and all three composite endpoints, and individually for pregnancy-induced hypertension (PIH), preeclampsia, gestational diabetes mellitus (GDM), large-for-gestational-age (LGA) neonates; but not for small-for-gestational-age neonates and preterm birth. Within the reference interval, BMI was associated with the composite maternal endpoint, PIH, GDM and LGA, with adjusted relative risks of 1.15 (95%CI 1.06-1.26), 1.12 (95%CI 1.00-1.26), 1.31 (95%CI 1.11-1.55) and 1.09 (95%CI 1.01-1.17). CONCLUSIONS: Graded increase in maternal BMI appears to be an indicator of risk for adverse pregnancy outcomes even among women with a BMI within the reference interval. The extent to which BMI directly contributes to the increased risk in this group should be evaluated in order to determine strategies most valuable for promoting safety and long-term health for mothers and their offspring.


Assuntos
Peso ao Nascer , Diabetes Gestacional/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Pré-Eclâmpsia/epidemiologia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Recém-Nascido , Idade Materna , Gravidez , Estudos Prospectivos
13.
PLoS One ; 16(9): e0256906, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34469481

RESUMO

BACKGROUND: Lactation results in substantial maternal bone loss that is recovered following weaning. However, the mechanisms underlying this recovery, and in particular the role of insulin-like growth factor 1 (IGF-I), is not clear. Furthermore, there is little data regarding whether recovery is affected by advanced maternal age. METHODS: Using micro-computed tomography, we studied bone recovery following lactation in mice at 2, 5 and 7 months of age. We also investigated the effects of reduced IGF-I availability using mice lacking PAPP-A2, a protease of insulin-like growth factor binding protein 5 (IGFBP-5). RESULTS: In 2 month old mice, lactation affected femoral trabecular and cortical bone, but only cortical bone showed recovery 3 weeks after weaning. This recovery was not affected by deletion of the Pappa2 gene. The amount of trabecular bone was reduced in 5 and 7 month old mice, and was not further reduced by lactation. However, the recovery of cortical bone was impaired at 5 and 7 months compared with at 2 months. CONCLUSIONS: Recovery of the maternal skeleton after lactation is impaired in moderately-aged mice compared with younger mice. Our results may be relevant to the long-term effects of breastfeeding on the maternal skeleton in humans, particularly given the increasing median maternal age at childbearing.


Assuntos
Doenças Ósseas Metabólicas/fisiopatologia , Lactação/metabolismo , Idade Materna , Osteogênese/fisiologia , Fatores Etários , Animais , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/genética , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/fisiopatologia , Proteínas de Transporte/sangue , Proteínas de Transporte/metabolismo , Osso Cortical/diagnóstico por imagem , Osso Cortical/fisiopatologia , Modelos Animais de Doenças , Feminino , Fator de Crescimento Insulin-Like I/análise , Fator de Crescimento Insulin-Like I/metabolismo , Camundongos , Camundongos Knockout , Gravidez , Proteína Plasmática A Associada à Gravidez/genética , Proteína Plasmática A Associada à Gravidez/metabolismo , Microtomografia por Raio-X
14.
Sci Rep ; 11(1): 17777, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493809

RESUMO

The elucidation of dynamic metabolomic changes during gestation is particularly important for the development of methods to evaluate pregnancy status or achieve earlier detection of pregnancy-related complications. Some studies have constructed models to evaluate pregnancy status and predict gestational age using omics data from blood biospecimens; however, less invasive methods are desired. Here we propose a model to predict gestational age, using urinary metabolite information. In our prospective cohort study, we collected 2741 urine samples from 187 healthy pregnant women, 23 patients with hypertensive disorders of pregnancy, and 14 patients with spontaneous preterm birth. Using gas chromatography-tandem mass spectrometry, we identified 184 urinary metabolites that showed dynamic systematic changes in healthy pregnant women according to gestational age. A model to predict gestational age during normal pregnancy progression was constructed; the correlation coefficient between actual and predicted weeks of gestation was 0.86. The predicted gestational ages of cases with hypertensive disorders of pregnancy exhibited significant progression, compared with actual gestational ages. This is the first study to predict gestational age in normal and complicated pregnancies by using urinary metabolite information. Minimally invasive urinary metabolomics might facilitate changes in the prediction of gestational age in various clinical settings.


Assuntos
Idade Gestacional , Aprendizado de Máquina , Metabolômica , Complicações na Gravidez/urina , Gravidez/urina , Adulto , Índice de Massa Corporal , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hipertensão Induzida pela Gravidez/urina , Recém-Nascido , Japão , Idade Materna , Modelos Biológicos , Paridade , Estudos Prospectivos
15.
PLoS One ; 16(9): e0257758, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34559861

RESUMO

BACKGROUND: Inappropriate infant and young child feeding (IYCF) practice is the leading cause of malnutrition in children. Data is needed to identify children at risk of poor feeding practice and to target interventions to improve IYCF practices. Therefore, this study aimed to assess IYCF practice and associated factors among mothers of children age 6 to 23 months in Debrelibanos district, north Showa zone, Oromia region, Ethiopia. METHOD: A community-based cross-sectional study design was conducted among 380 mothers of children age 6 to 23 months from March 1 to April 5, 2019. A simple random sampling technique was used to select the respondents. Data was collected using a structured interviewer-administered questionnaire that had been pretested. The data was entered into Epi-Data 3.1 and then transferred to SPSS 21 for analysis. Descriptive statistical analysis was done, and an association between an outcome variable and independent variables was examined in logistic regression models. RESULT: Overall, 65.8% of mothers practiced appropriate IYCF practice. The study revealed that 70.5% of children started breastfeeding within one hour of birth, and 61.6% were breastfed exclusively for six months. Among studied mothers, 79.5% continued to breastfeed their children until 2 years, and 69.2% of the participants started complementary feeding timely at six months. Minimum dietary diversity was observed in 19.2% of children, while minimum meal frequency was found in 79.2%. The majority of mothers (77.6%) fed their babies with bottles. Mother's educational status of primary school [AOR = 4.50, 95% CI: (1.38,14.61)], husband's occupation being merchant [AOR = 6.45, 95% CI: (1.51, 27.59)]; antenatal care follows up [AOR = 3.15, % CI: (1.22, 8.12)], radio/television ownership [AOR = 7.41, 95% CI: (2.86, 19.20)], child's sex being female [AOR = 4.78, 95% CI: (2.26, 10.064) and sufficient knowledge on child feeding [AOR = 2.82, 95% CI: (1.27, 26.26)] were independent predictors for appropriate IYCF practice. CONCLUSION: The prevalence of appropriate infant and young child feeding practice indicators was found to be rather high among the mothers in this study. The use of a bottle to feed babies, in particular is very common among the mothers who were studied. To address child malnutrition, it is critical to educate families about proper IYCF practices. This study suggests that mothers be properly educated about IYCF recommendations at health care facilities during their visits, as well as the promotion of appropriate IYCF through various media.


Assuntos
Alimentação Artificial/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição do Lactente , Desnutrição/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Escolaridade , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Idade Materna , Prevalência , Adulto Jovem
16.
Nutrients ; 13(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34578976

RESUMO

BACKGROUND: Over the past year, there has been a rise in twin births. The current scientific consensus recommended breast-feed milk for all newborns for at least 6 months. They stated that it is possible to meet the nutritional needs of two or more newborns with only one mother's milk. More information would be desirable about the factors that influence or lead to the initiation and interruption of breastfeeding. The quality of the evidence available from multiple studies has been inconclusive and therefore led to controversial interpretations and practices. AIMS: The first aim of this study was to analyze the extent of the feeding of multiples with breast milk in the experience of our clinical unit in terms of incidence and duration. The second objective was to evaluate the correlation between maternal, perinatal and neonatal variables with breast milk feeding rates and duration. METHODS: The study was conducted between 2015 and 2020, in a NICU in Southern Italy (San Giovanni Rotondo, Foggia). Sixty-one women who have given birth to multiples were enrolled into the study. Newborn data were retrospectively collected by informatic database and breastfeeding information were collected by a questionnaire. RESULTS: In our centre, the percentage of twins out of the total number of births over the years has almost doubled from 1.28% in 2015 to 2.48% in 2020 and the 88% of twins are premature. 18.1% received breast milk for more than 6 months and 6.3% received it for more than 12 months. Infants of lower gestational age and weight, born to multiparous, more mature and medium-high schooling mothers received breast milk for a longer period. 35% of women explained that the interruption of breastfeeding was due to the insufficient milk production and 41% to the stress and difficulties in managing the twins. Qualitative analysis of maternal narrative revealed, for many of them, the awareness of the importance of breastfeeding and the efforts made to try to give breast milk, but also fears about the quantity of milk and satiety of their children. CONCLUSIONS: It is important to identify the factors both favoring and obstructing maternal milk feeding of multiples and it would be desirable the activation of a network of training and support for mothers after discharge, with particular regard to the categories found to be less inclined.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Gêmeos/estatística & dados numéricos , Adulto , Feminino , Idade Gestacional , Humanos , Lactente , Alimentos Infantis/estatística & dados numéricos , Recém-Nascido , Itália , Lactação , Idade Materna , Pessoa de Meia-Idade , Paridade , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
17.
Sci Rep ; 11(1): 17499, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34471152

RESUMO

Maternal effects can shape the phenotypes of offspring, but the extent to which a layer breeder's experience can affect commercial laying hens remains unclear. We aimed to investigate the effects of maternal age and maternal environment on laying hens' behaviour and stress response. In our first experiment (E1), commercial hybrid hens were reared either in aviary or barren brooding cages, then housed in aviary, conventional cages or furnished (enriched) cages, thus forming different maternal housing treatments. Hens from each treatment were inseminated at three ages, and measures of response to manual restraint and social stress were assessed in offspring. In experiment 2 (E2), maternal age effects on offsprings' stress response were further investigated using fertile eggs from commercial breeder flocks at three ages. In E1, maternal age affected struggling and corticosterone during manual restraint, feather pecking and pulling and comb wounds. Additionally, maternal rearing and housing in aviary systems showed positive effects on measures of behaviour and stress response in offspring. Effects of maternal age were not replicated in E2, possibly due to methodological differences or higher tolerance to maternal effects in commercial breeders. Overall, we recommend researchers report parent stock age to increase comparison across studies and thus our understanding of maternal age effects.


Assuntos
Comportamento Animal/fisiologia , Meio Ambiente , Plumas/fisiologia , Idade Materna , Comportamento Social , Estresse Psicológico , Criação de Animais Domésticos , Animais , Animais Recém-Nascidos , Galinhas , Ovos , Feminino , Masculino , Restrição Física
18.
Enferm. foco (Brasília) ; 12(2): 223-229, set. 2021. ilus, tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1291237

RESUMO

Introdução: o adiamento da gestação ocorre por motivos diversos e possui maior risco de desenvolver complicações maternas, fetais e neonatais. O período do pré-natal se torna um momento propício para promoção da saúde dessas gestantes. Objetivo: descrever o perfil clínico da gestante com idade igual ou superior a 35 anos em um município de tríplice fronteira. Métodos: pesquisa quantitativa, do tipo retrospectiva e descritiva. Os dados são de prontuários de mulheres com idade igual ou maior que 35 anos que passaram por parto no período de 2012 a 2016. Para análise dos dados foi realizado o teste Qui-quadrado. Resultados: no período ocorreram 2.605 partos de gestações tardias, a maioria era brasileira e multípara e o parto cirúrgico o mais realizado. Quanto ao pré-natal, a maioria realizou. As intercorrências gestacionais mais encontradas foram a hipertensão arterial, diabetes mellitus e a pré-eclâmpsia. O parto cirúrgico teve maior incidência para prematuridade, baixo peso e como desfecho neonatal, a unidade de terapia neonatal. Conclusão: o perfil clínico das gestantes estudadas corrobora com outros resultados nacionais. Diante dos resultados evidenciados, destaca-se a importância dos profissionais de saúde conheçam os fatores de risco que as gestantes tardias estão expostas, para atuarem na prevenção de tais agravos. (AU)


Objective: To describe the clinical profile of pregnant women 35 years of age or older in a triple border city. Methods: Quantitative research, retrospective and descriptive. Data are from medical records of women aged 35 years or older who underwent labor from 2012 to 2016. For data analysis, the Chi-square test was performed. Results: There were 2,605 late pregnancies during the period, most were Brazilian and multiparous and the most performed surgical delivery. Most pregnant women had prenatal care. The most common gestational complications were hypertension, diabetes mellitus and preeclampsia. Surgical delivery had a higher incidence for prematurity, low weight and as a neonatal outcome, the neonatal therapy unit. Conclusion: The clinical profile of the pregnant women studied corroborates with other national results. Given the evidenced results, it is highlighted the importance of health professionals to know the risk factors to which late pregnant women are exposed to effectively act in the prevention of such diseases. (AU)


Objetivo: Describir el perfil clínico del gerente de 35 años o más en el municipio de frontera múltiple. Métodos: Investigación cuantitativa, retrospectiva y descriptiva. Los datos están listos para mujeres de 35 años o más y que alcanzan el período de 2012 a 2016. Para el análisis de los datos realizados o la prueba de Chi-cuadrado. Resultados: En el período en que ocurrieron 2,605 partes de contribuciones tardías, la mayoría fueron brasileñas y multíparas y el procedimiento quirúrgico o más realizado. En cuanto a la atención prenatal, la mayoría se realiza. Como las complicaciones gestacionales más comunes fueron hipertensión, diabetes mellitus y preeclampsia. El parto quirúrgico tuvo una mayor incidencia de prematuridad, bajo peso y, como resultado neonatal, una unidad de terapia neonatal. Conclusión: El perfil clínico de las embarazadas estudiadas se confirma con otros resultados nacionales. En vista de los resultados evidenciados, que muestran la importancia de los profesionales de la salud, los factores de riesgo que se retrasan están expuestos para actuar en la prevención de tales lesiones. (AU)


Assuntos
Educação em Saúde , Idade Materna , Enfermagem , Promoção da Saúde
19.
Afr Health Sci ; 21(1): 320-326, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34394313

RESUMO

Background: Caesarean delivery is an essential surgical skill within the primary care setting aimed at reducing maternal morbidity and mortality. Objectives: To determine the rate and indications for caesarean deliveries with a view to improving on the service delivery in the study area. Methods: A retrospective review of all caesarean deliveries over a five-year period, January 1st, 2012 to December 31st, 2016. Results: A total of 2321 deliveries were recorded during the study duration and 481 of them were through caesarean section (CS) giving a caesarean section rate of 20.4%. The rate was higher in the multigravida 255 (53.1%). The commonest indication for caesarean section was previous caesarean section 131 (27.2%). Emergency caesarean delivery accounted for 278 (57.8%). Only 16 (3.3%) stayed more than five days postoperatively while the rest, 465 (96.7%), stayed less than five days. There was a gradual yearly increase in rate from 12.1% in 2012 to 19.5% in 2016. Conclusion: The rate of CS in this study has shown a gradual yearly increase with emergency CS having a higher percentage. Early diagnosis and referral of high-risk pregnancies from peripheral hospitals could reduce emergency CS among the study population.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Adulto , Cesárea/mortalidade , Feminino , Hospitais de Ensino , Humanos , Recém-Nascido , Masculino , Idade Materna , Nigéria/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco
20.
Afr Health Sci ; 21(1): 338-348, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34394315

RESUMO

Background: Fetal ear length measurement has been associated with some clinical values: sonographic marker for chromosomal aneuploidy and for biometric estimation of fetal gestational age. Objectives: To establish a baseline reference value for fetal ear length and to assess relationship between fetal ear length and gestational age. Methods: Ear length measurements were obtained prospectively from fetuses in 551 normal singleton pregnancies of 15 to 41 weeks gestation. Normal cases were defined as normal sonographic findings during examination plus normal infant post-delivery. The relationship between gestational age (GA) in weeks and fetal ear length (FEL) in millimeters were analyzed by simple linear regression. Correlation of FEL measurements with GA, biparietal diameter (BPD), Head circumference (HC), Abdominal Circumference (AC), Femur Length (FL) and maternal age (MA) were also obtained. Results: Linear relationships were found between FEL and GA (FEL=0.872GA-2.972). There was a high correlation between FEL and GA (r = 0.837; P = .001). Good linear relationship and strong positive correlation were demonstrated between FEL and BPD, AC, HC, and FL (p<0.05). Conclusion: The result of this study provides normal baseline reference value for FEL. The study also showed good linear relationship and good correlation between FEL and fetal biometric measurements.


Assuntos
Biometria/métodos , Orelha/diagnóstico por imagem , Orelha/embriologia , Feto/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Aberrações Cromossômicas , Feminino , Idade Gestacional , Humanos , Masculino , Idade Materna , Gravidez , Valores de Referência
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