Iron deficiency and thyroid dysfunction among sudanese women in first trimester of pregnancy: a cross-sectional study.

BACKGROUND: Pregnant women are more susceptible to iron deficiency (ID), and it can lead to several maternal and perinatal adverse effects. There are some published data on the effect of ID on thyroid function, but none of the studies were conducted in sub-Saharan African countries including Sudan. This study was conducted to investigate association between ID (ferritin < 15 µg/L) and thyroid functions [thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4)] among Sudanese women in the first trimester of pregnancy. METHOD: A cross-sectional study was conducted in Saad Abuelela Maternity Hospital, Sudan. Obstetric/sociodemographic characteristics were gathered through questionnaires. Hemoglobin, serum ferritin, TSH, FT3, and FT4 were measured in all pregnant women. Continuous variables were compared with either independent sample t-test if they were normally distributed, or with Mann-Whitney U- test if they were not-normally distributed. Spearman correlations were performed between the continuous variables. RESULTS: In total, 127 pregnant women with mean [standard deviation (SD)] age of 27.0 (5.5) years and gestational age of 10.5 (3.0) weeks, respectively, were enrolled in this study. Forty-seven (37.0%) of these 127 women had ID. While the median [interquartile range (IQR)] of the parity, TSH, and FT3 were not different between women with ID and women without ID, the median (IQR) of FT4 was significantly lower in women with ID compared with women without ID [1.020 (0.910‒1.120) vs. 1.095 (0.990‒1.217) pmol, P = 0.014]. Serum ferritin was inversely correlated with FT3, (r = -0.225, P = 0.011). There was no significant correlation between serum ferritin, TSH, and FT4. CONCLUSIONS: Iron deficiency was common during the first trimester of pregnancy and was associated with thyroid dysfunctions. Therefore, ID should be evaluated to avoid thyroid dysfunction.

Association between previous spontaneous abortion and preeclampsia: a case-control study.

BACKGROUND: The association between previous spontaneous abortion and preeclampsia is not yet fully understood. The current study was conducted to assess the association between previous spontaneous abortion and preeclampsia among pregnant women in Sudan. METHODS: A case-control study (involving 180 women in each study group) was conducted at Saad Abuelela Hospital, Khartoum, Sudan. The cases were pregnant women with preeclampsia, while the control group included healthy pregnant women. The participants' sociodemographic, obstetric, and clinical characteristics were assessed via a questionnaire. RESULTS: There was no significant difference in the age, parity, education level, employment status, blood group, body mass index, and hemoglobin level between the patient and control groups. Forty (22.2%) women with preeclampsia and 68 (37.8%) women in the control group had a history of spontaneous abortion (p = 0.001). Multivariate logistic regression analysis (adjusted) revealed that women with a history of spontaneous abortion had a lower risk of preeclampsia than those without a history of spontaneous abortion [adjusted odds ratio (AOR) = 0.44, 95% confidence interval (CI) = 0.26‒0.73]. However, women with a history of preeclampsia had a higher risk of recurrence of preeclampsia (AOR = 1.92, 95% CI = 1.11‒3.32). CONCLUSION: The present study revealed that previous spontaneous abortion reduced the risk of preeclampsia by 59.0%.

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

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

High haemoglobin levels in early pregnancy and gestational diabetes mellitus among Sudanese women.

A longitudinal study was carried out to investigate the prevalence and risk factors (including haemoglobin levels) for gestational diabetes mellitus (GDM) in Khartoum, Sudan. The study was carried out at Saad Abuelela Hospital (Khartoum, Sudan) during February to November 2017. Pregnant women in early pregnancy (gestational age <14 weeks) were enrolled in the study. The detailed medical and obstetrics history was recorded for each participant using a questionnaire. The women were then followed up, where a 75-g oral glucose tolerance test was performed at 24 - 28 weeks of gestation. Of 290 women, 259 (89.3%) completed the follow-up. The mean (standard deviation [SD]) of the age, gravidity and gestational age at enrolment were 28.02 (5.7) years, 2.37 (2.42) and 10.86 (2.63) weeks, respectively. Forty-eight women (18.5%) had GDM. Binary regression showed that while age, parity, residence, education and body mass index (BMI) were not associated with GDM, a high haemoglobin level was the only factor associated with GDM (OR = 1.52, 95% confidence interval [CI] = 1.07 - 2.16, p = .019). Women with haemoglobin > 10.8 g/dl were at a higher risk of GDM (OR = 2.52, 95% CI = 1.02 - 6.27, p = .044). There is a high prevalence of GDM, especially among women with high haemoglobin levels.Impact statementWhat is already known on this subject? Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy, contributing significantly to maternal, perinatal morbidity and mortality and can lead to adverse consequences for the health of both mother and offspring later in life. The rate of GDM varies with the various settings and populations, and a prevalence of 1-14% has been reported depending on the population studied. High haemoglobin levels were recently reported to be associated with GDM.What do the results of this study add? There is a high prevalence of GDM in Khartoum, Sudan, especially among women with high haemoglobin levels in early pregnancy.What are the implications of these findings for clinical practice and/or further research? Haemoglobin levels could be used as reliable markers to detect GDM. These markers could be used in the prevention of GDM.

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

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

Heart rate variability and hematological parameters in pregnant women.

BACKGROUND: There are few researches on hematological parameters (hemoglobin, red cell distribution width [RDW], white blood cells [WBCs], mean platelets volume [MPV], and heart rate variability [HRV]). There are no published data on this concept (HRV and hematological parameters) during pregnancy. METHODS: A cross-sectional study was conducted at Saad Abul Ela hospital in Khartoum, Sudan during the period of July to August 2018. Pregnant women with singleton, a live baby, were enrolled in this study. Clinical history and examination were performed. HRV (autonomic modulation) was assessed using time and frequency domain HRV indices. RESULTS: One hundred and five pregnant women were enrolled. The median (quartile) of the age, parity, and gestational age was 30.0 (25.0-35.0) years, 1.0 (0-3.0), and 38.0 (32.0-39.0) weeks, respectively. While there were positive correlations between hemoglobin and low frequency (LF), RDW and high frequency (HF), WBCs and HF Norm, WBCs and LF/HF, MPV and HF Norm, LF Norm and LF/HF, there was no significant correlation between the hematological (hemoglobin, WBCs, RDW, and MPV) and HRV parameters. Linear regression analysis showed no significant association between age, parity, gestational age, body mass index, hemoglobin, RDW, and HRV variables. The Log10 WBCs were negatively associated with Log10 HF (ms2 /Hz). MPV was positively associated with LF Norm and negatively associated with HF Norm. CONCLUSION: The study failed to show significant associations between age, parity, gestational age, hemoglobin, RDW, and HRV variables. The WBCs were negatively associated with HF. MPV was positively associated with LF Norm, and it was negatively associated with HF Norm.

Serum magnesium and high-sensitivity C-reactive protein as a predictor for gestational diabetes mellitus in Sudanese pregnant women.

BACKGROUND: Gestational diabetes mellitus (GDM) is a big health problem that adversely affects both the maternal and perinatal outcomes. We aimed to predict the development of GDM in the first trimester using high sensitivity C-reactive protein (hs-CRP) and serum magnesium. METHODS: The study conducted in the antenatal care clinic of Saad Abualila Hospital (Khartoum, Sudan). Pregnant women were enrolled in this longitudinal cohort study during first trimester ≤14 weeks of gestation. Serum hs-CRP and magnesium concentrations were measured between weeks 11 and 14 of gestation. Glucose tolerance test and fasting plasma insulin (FPI) measurement were performed between 24 and 28 weeks gestational age. To assess insulin sensitivity and ß-cell function, Homeostatic Model Assessment Insulin Resistance (HOMA-IR), HOMA-ß indices and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated and used. RESULTS: Out of the 126 who completed the study 19 (15%) were diagnosed as GDM. The median (interquartile) of FBG was significantly higher in women with GDM [81 (70-95) vs. 67(60-75) mg/dl; P = < 0.001] compared to women without GDM. There was no significant difference in hs-CRP, serum magnesium, HOMA-IR, QUICKI and HOMA- ß between women with GDM and women without GDM. No correlation was observed between body mass index (BMI), serum magnesium, hs-CRP, FBG and insulin levels. CONCLUSIONS: First trimester hs-CRP and serum magnesium levels were not correlated with the later development of gestational diabetes in this setting.

Hepatitis B infection and preeclampsia among pregnant Sudanese women.

BACKGROUND: Previous published studies have reported conflicting results of association between hepatitis B virus (HBV) infection and preeclampsia. There was no published data on HBV and preeclampsia in Africa including Sudan. The aim of the present study was to investigate the association between HBsAg seropositivity and preeclampsia. METHODS: A case -controls study (200 women in each arm) was conducted at Saad Abualila Maternity Hospital, Khartoum, Sudan. The cases were women with preeclampsia and the controls were healthy pregnant women. Socio-demographic characteristics were gathered using questionnaire and HBsAg was investigated using an ELISA. RESULTS: There was no significant difference between the cases and the controls in their age, parity, residence, education and blood groups. The majority of the cases were mild preeclampsia (159; 79.5%). In comparison with the controls, a significantly higher number of the cases were HBsAg seropositive [30 (15.0%) vs.12 (6.0%), P = 0.005]. In binary regression women with HBsAg seropositive were at higher risk of preeclampsia than women who were HBsAg seronegative (OR = 2.86, 95%, CI = 1.41-5.79, P = 0.003). CONCLUSION: In the current study HBsAg seropositivity is associated with preeclampsia. Preventive measure should be implemented.

Estimating malaria parasite density among pregnant women at central Sudan using actual and assumed white blood cell count.

BACKGROUND: Microscopic examination using Giemsa-stained thick blood films remains the reference standard for detection of malaria parasites and it is the only method that is widely and practically available for quantifying malaria parasite density. There are few published data (there was no study during pregnancy) investigating the parasite density (ratio of counted parasites within a given number of microscopic fields against counted white blood cells (WBCs) using actual number of WBCs. METHODS: Parasitaemia was estimated using assumed WBCs (8,000), which was compared to parasitaemia calculated based on each woman's WBCs in 98 pregnant women with uncomplicated Plasmodium falciparum malaria at Medani Maternity Hospital, Central Sudan. RESULTS: The geometric mean (SD) of the parasite count was 12,014.6 (9,766.5) and 7,870.8 (19,168.8) ring trophozoites /µl, P <0.001 using the actual and assumed (8,000) WBC count, respectively. The median (range) of the ratio between the two parasitaemias (using assumed/actual WBCs) was 1.5 (0.6-5), i e, parasitaemia calculated assuming WBCs equal to median (range) 1.5 (0.6-5) times higher than parasitaemia calculated using actual WBCs. There were 52 out of 98 patients (53%) with ratio between 0.5 and 1.5. For 21 patients (21%) this ratio was higher than 2, and for five patients (5%) it was higher than 3. CONCLUSION: The estimated parasite density using actual WBC counts was significantly lower than the parasite density estimated using assumed WBC counts. Therefore, it is recommended to use the patient`s actual WBC count in the estimation of the parasite density.

Epidemiology of hepatitis B and hepatitis C virus infections in pregnant women in Sana'a, Yemen.

BACKGROUND: Screening for Hepatitis B and C during pregnancy may help to decide on appropriate antiviral therapy and the institution of steps to minimize vertical transmission to the newborn infants. METHODS: A cross-sectional study was conducted during November-December 2011 to investigate the seroprevalence and associated risk factors for markers of HBV (hepatitis B surface antigen; HBsAg) and anti-HCV antibody among pregnant women at the Al-Thawra hospital in Sana'a, Yemen. Structured questionnaires were used to obtain sociodemographic obstetrics and medical data and sera were tested for HBsAg and anti-HCV. RESULTS: Of the 400 pregnant women enrolled in the study, HBsAg and anti-HCV were detected in 43 (10.8%; 95% CI: 8.0-14.0%) and 34 (8.5%, 95% CI: 6.0-11.5%) women, respectively. None of the women were co-infected with HBV and HCV. Multivariate analysis showed that circumcision was significantly associated with HBsAg seropositivity (OR = 3.3, 95% CI: 1.1-10.2; p = 0.03), low parity (primigravidae and secundigravidae) and education below secondary level were significantly associated with anti- HCV seropositivity (OR = 3.3, 95% CI: 1.1-10.2; p = 0.03). No other sociodemographic or clinical characteristics (age, residence, history of home delivery, miscarriage, dental manipulation, surgery, and blood transfusion) were significantly associated with HBsAg or anti-HCV seropositivity. CONCLUSION: The results of this study suggest that HBsAg and anti-HCV have high prevalence among pregnant women.

Early pregnancy serum levels of folate and vitamin B12 in overweight and obese women in Khartoum, Sudan.

BACKGROUND: This study was conducted to assess serum levels of folate and vitamin B12 in overweight and obese pregnant women. METHODS: A cross-sectional study was conducted at Saad Abualila Hospital, Sudan. Clinical data were collected through questionnaires and body mass index (BMI) was computed from weight and height. The serum folate and vitamin B12 levels were analyzed by immunofluorescence. RESULTS: Of 300 enrolled women, 44.7% were of normal weight, 32.3% were overweight and 3.0% were obese. The folate level was significantly lower in overweight women (median 4.79 ng/ml [IQR 2.70‒7.70]) than in normal-weight women (median 6.650 ng/ml [IQR 3.30‒10.55]; p=0.022). There was no significant difference in the prevalence of marginal and severe folate deficiencies in women in different BMI groups. Compared with normal-weight women (median 197.5 pg/ml [IQR 150.0‒263.0]), obese women (median 173.0 pg/ml [IQR 150.0‒213.0]; p=0.038) had significantly lower vitamin B12 levels and had a higher prevalence of vitamin B12 insufficiency. Fair negative correlations (p<0.01) were observed between folate and BMI (r = -0.157) and between vitamin B12 and BMI (r = -0.173). CONCLUSIONS: Overweight and obese pregnant Sudanese women had lower levels of serum folate and vitamin B12.

Thrombocytopenia in pregnant women with Plasmodium falciparum malaria in an area of unstable malaria transmission in eastern Sudan.

BACKGROUND: Blood platelet levels are being evaluated as predictive and prognostic indicators of the severity of malaria infections in humans. However, there are few studies on platelets and Plasmodium falciparum malaria during pregnancy. METHODS: A case-control study was conducted at Gadarif Hospital in Eastern Sudan, an area characterized by unstable malaria transmission. The aim of the study was to investigate thrombocytopenia in pregnant women with P. falciparum malaria (cases) and healthy pregnant women (controls). RESULTS: The median (interquartile) platelet counts were significantly lower in patients with malaria (N = 60) than in the controls (N = 60), 61, 000 (43,000-85,000) vs. 249,000 (204,000-300,000)/µL, respectively, p < 0.001. However, there was no significant difference in the platelet counts in patients with severe P. falciparum malaria (N = 12) compared with those patients with uncomplicated P. falciparum malaria (N = 48), 68, 000 (33,000-88,000)/µL vs. 61, 000 (45,000-85,000)/µL, respectively, p = 0.8. While none of the control group had thrombocytopenia (platelet count <75, 000/µL), it was found that 6/12 (50%) and 27/48 (56.2%) (p <0.001) of the patients with severe malaria and uncomplicated malaria had thrombocytopenia, respectively. Pregnant women with P. falciparum malaria, compared with the pregnant healthy control group, were at higher risk (OR = 10.1, 95% CI = 4.1-25.18; p < 0.001) of thrombocytopenia. Two patients experienced bleeding, and there was one maternal death due to cerebral malaria where the patient's platelet count was only 28,000/µL. CONCLUSION: P. falciparum malaria is associated with thrombocytopenia in pregnant women in this setting. More research is needed.

Evaluation of the association between haemoglobin levels and preterm birth at Khartoum, Sudan: A hospital-based study.

Objective: The objective of this study was to determine the association between haemoglobin level and PB. Methods: A cross-sectional study was conducted in Khartoum, Sudan. Questionnaires on demographics and medical and obstetric factors were completed. A logistic regression analysis was performed. Results: Of the 1,716 pregnant women, approximately two-thirds (65.7%) had anaemia (haemoglobin < 11 g/dl) and six (0.3%) had severe anaemia (haemoglobin < 8 g/dl). Of the 1,716 women, 283 (16.5%) had a PB. In multivariable logistic regression, parity (AOR = 1.15, 95% CI = 1.09-1.21, P < 0.001) was positively associated with PB. Compared to those with haemoglobin levels of 10-10.9 g/dl, pregnant women with haemoglobin levels of 8-8.9 (AOR = 0.41, 95% CI = 0.22-0.77), 9-9.9 (AOR = 0.59, 95% CI = 0.38-0.91), and 11-11.9 g/dl (AOR = 0.53, 95% CI = 0.36-0.77) were at a lower risk of PB. Women with haemoglobin levels of 12-13 g/dl were at a higher risk of PB (AOR = 1.62, 95% CI = 1.06-2.45). There was no significant association between women with haemoglobin levels < 8 g/dl and > 13 g/dl and PB. Conclusion: This study showed different levels of association between haemoglobin levels and PB.

Maternal Undernutrition and Low Birth Weight in a Tertiary Hospital in Sudan: A Cross-Sectional Study.

Background: The World Health Organization set a Global Nutrition Target of a 30% reduction in LBW by 2025. Maternal malnutrition/undernutrition is among the most important modifiable risk factors for impaired fetal growth. This study investigates the effect of maternal undernutrition on LBW in Sudan. Methods: A cross-sectional study was conducted at Saad Abuelela Hospital in Khartoum, Sudan, from May to October 2020. The sociodemographic and obstetric data of the women were gathered via questionnaire, and their mid-upper arm circumference (MUAC) was measured. Maternal undernutrition was defined as a MUAC of <23 cm. Results: In total, 1,505 pairs of pregnant women and their newborns were enrolled in the study. The medians [interquartile (IQR)] of the age, parity, and gestational age were 27.0 (9.0) years, 1.0 (3.0), and 38.0 (2.0) weeks, respectively. The median (IQR) of the birth weight was 3,028.0 (690.0) g. Of the 1,505 participants, 182 (12.1%) delivered LBW infants. Multivariate logistic regression showed that MUAC [adjusted odds ratio (AOR) = 0.91, 95% confidence interval (CI) = 0.87-0.96] and gestational age (AOR = 0.79, 95% CI = 0.73-0.85) were negatively associated with LBW. The level of antenatal care <2 visits (AOR = 2.10, 95% CI = 1.30-3.57) was associated with LBW. Women with undernutrition were at a higher risk of delivering LBW infants (AOR = 1.66, 95% CI = 1.09-2.53). Conclusion: LBW is a health problem in Sudan, and women with undernutrition were at a higher risk of delivering LBW infants.

Prevalence and associated factors of undernutrition among pregnant Sudanese women.

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

Blood Groups and Hematological Parameters Do Not Associate with First Trimester Gestational Diabetes Mellitus (Institutional Experience).

OBJECTIVE: There are few published researches on blood groups, hematological parameters [hemoglobin, red cell distribution width (RDW), white blood cells (WBCs), mean platelets volume (MPV)] and gestational diabetes mellitus (GDM). The aim of this study was to investigate the association of haematological indices with GDM in early pregnancy. METHODS: The study was carried out at Saad Abuelela Hospital (Khartoum, Sudan) during March-November of 2018. Pregnant Sudanese women in early pregnancy (gestational age <14 weeks) were enrolled in the study. The details of the medical and obstetrics history were recorded. The women were then followed up until 24-28 weeks of gestation when a 75-gram oral glucose tolerance test was performed. RESULTS: Two hundred and fifty-three women at 10.2 week of gestational age completed the follow-up. The mean (SD) of the age and gravidity at the initial antenatal visit were 28.03 (5.6) years, 2.32 (2.41). The mean (SD) of body mass index (BMI) was 27.28 (24.41-30.80) kg/m2. Fifty women (19.8%) had GDM. Age, parity, BMI, place of residence, employment and education were not significantly different between the two groups. Moreover, there was no significant difference in the blood groups and hematological parameters between women with and without GDM. CONCLUSION: In this study, the blood groups and other hematological parameters were not different between women with and without GDM.

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

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

Maternal early pregnancy serum level of 25-Hydroxyvitamin D and risk of gestational diabetes mellitus.

OBJECTIVE: To assess if early pregnancy (≤14 weeks of gestation) 25-hydroxyvitamin D (25(OH)D) level is associated with risk of gestational diabetes mellitus (GDM). METHODS: A nested case-control study (60 women in each arm) was conducted at Saad Abualila Hospital (Khartoum, Sudan) during the period of January to November 2017. Clinical and obstetrical data were gathered, 25(OH)D concentration was measured at the first prenatal visit, and a 75-g oral glucose tolerance test was performed at 24-28 weeks of gestation. RESULTS: Compared with women without GDM, in women with GDM, the median of the 25(OH)D level was significantly lower (7.3 [interquartile range 5.7-8.8] ng/mL versus 8.4 [interquartile range 6.6-11.9] ng/mL, P=0.001). All women in the study (with and without GDM) had vitamin D deficiency (25(OH)D<20 ng/mL). The results of the logistic regression showed that a low 25(OH)D level was the only factor associated with GDM (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.73-0.95, P=0.010). Women with 25(OH)D less than 6.0 ng/mL were at a higher risk of GDM (OR 3.2, 95% CI 1.29-8.12, P=0.012). CONCLUSION: A low 25(OH)D level in early pregnancy was associated with increased risk of GDM. This finding might be useful in predicting GDM.

Low and high birth weight in a hospital population in Sudan: An analysis of clinical cut-off values.

OBJECTIVE: To determine the cut-off values for low birth weight (LBW) and high birth weight (HBW) of Sudanese newborns. METHODS: Data (maternal age, parity, birth weight, and gender of the newborn) from women (n = 2818) who delivered at Saad Abualila Hospital in Khartoum were retrieved from the medical files. RESULTS: The cut-off for LBW (the 10th centile) was 2400 g and the 90th centile (HBW) was 3700 g. Out of 2818 newborns, 317 (11.2%) had birth weights below 2400 g. Using the WHO (traditional) cut-off of 2500 g, the prevalence of LBW was 14.3%. The difference between the two prevalences of LBW was statistically significant (P < 0.001). However, the agreement rate between the two was high (κ = 0.86). The cut-off to define HBW was 3700 g. In the study, 292 (10.4%) newborns had birth weights of at least 3700 g. Using the cut-off of 4000 g, the prevalence of HBW was 9.5%. The difference between the two prevalences of HBW was statistically significant (P < 0.001). However, the agreement rate between the two was low (κ = 0.06). CONCLUSION: The cut-off values for low and high birth weight were 2400 and 3700 g, respectively.

Thyroid hormones profile among obese pregnant Sudanese women.

BACKGROUND: Previous studies evaluating thyroid function among obese pregnant women failed to demonstrate a consistent pattern of thyroid hormones profile, probably due to the variations in biological/environmental determinants of thyroid function in different countries. AIM: The aim of the study was to evaluate thyroid hormones profile in Sudanese pregnant women with varying degrees of obesity. PATIENTS AND METHODS: Obstetric/sociodemographic characteristics were gathered from 178 singleton pregnant Sudanese women using questionnaires. Weight and height were measured; body mass index (BMI) was calculated and categorized into four groups: Underweight (BMI <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2). Free triiodothyronine (FT3), free thyroxin (FT4), and thyroid-stimulating hormone (TSH) were measured. RESULTS: Of the 178 enrolled women, 9 (5.1%), 52 (29.2%), 73 (41.0%), and 44 (24.7%) were underweight, normal BMI, overweight, and obese, respectively. FT3 level was significantly higher in obese women compared with normal BMI (P=0.004) as well as overweight women (P=0.015). Higher FT3 levels were significantly associated with obesity (odds ratio [OR]=9.5, 95% confidence interval [CI] =3.1-29.0, P<0.001). Lower levels of FT4 were significantly associated with overweight (OR=0.06, 95% CI=0.007-0.58, P=0.015) and obesity (OR=0.048, 95% CI=0.004-0.5, P=0.018). Based on linear regression analysis, BMI was positively associated with FT3 (4.7 pmol/l, P<0.001) and negatively associated with FT4 (-8.26 pmol/l, P=0.001). CONCLUSIONS: BMI correlates with FT3 differently compared to FT4. Pregnant women with higher BMI are likely to have higher levels of FT3, but lower FT4. In contrast, TSH levels were comparable in different BMI groups. RELEVANCE FOR PATIENTS: Increased iodothyronine 5´deiodinase (5´D) activity associated with obesity may give an explanation for thyroid profile in those with higher BMI. High 5´ activity increases FT3 at the expense of FT4. Alternatively, high FT3 and low FT4 are expected to feedback differently on TSH, which explains the loss of positive correlation between BMI and TSH.