Mediators of adverse birth outcomes among socially disadvantaged women.

BackgroundThere has been an unprecedented rise in infant mortality rates in the UK since 2014, especially in disadvantaged areas. This trend is concerning since infant mortality is a sensitive indicator...

Retrospective studies of preconception health have demonstrated that parents' health conditions and behaviors can impact a newborn's birth outcomes and, subsequently, future health status. This study sought to examine the impact of preconception health, measured prospectively, among both mothers and fathers, on two important birth outcomes: birthweight and gestational age. Data came from Add Health (the National Longitudinal Study of Adolescent Health), which included interviews with original participants and a subsample of their partners in 2001-02. In 2008, the original respondents again completed an interview for Add Health. For 372 eligible infants born to these couples, birth outcomes (measured in 2008) were regressed on preconception health conditions and behaviors among non-pregnant heterosexual partners (measured in 2001-02). Mean birthweight was 3,399 g, and mean gestational age was 39 weeks. Birthweight was higher for infants born to mothers with diabetes or high blood pressure, and for mothers who drank alcohol at least once per month, and lower for infants born to fathers with diabetes (p < 0.05). Infant gestational age was marginally lower for infants born to mothers with higher levels of depression (p < 0.10), and lower for infants born to fathers with diabetes and with higher levels of fast food consumption (p < 0.05). Both maternal and paternal preconception health conditions and behaviors influenced infant birth outcomes. Interventions to promote preconception health should focus on prevention of diabetes and high blood pressure, as well as minimizing consumption of alcohol and fast food.

Maternal vitamin D status during pregnancy has been associated with infant birth and postnatal growth outcomes, but reported findings have been inconsistent, especially in relation to postnatal growth and adiposity outcomes. In a mother-offspring cohort in Singapore, maternal plasma vitamin D was measured between 26 and 28 weeks of gestation, and anthropometric measurements were obtained from singleton offspring during the first 2 years of life with 3-month follow-up intervals to examine birth, growth and adiposity outcomes. Associations were analysed using multivariable linear regression. Of a total of 910 mothers, 13·2 % were vitamin D deficient (<50 nmol/l) and 26·5 % were insufficient (50-75 nmol/l). After adjustment for potential confounders and multiple testing, no statistically significant associations were observed between maternal vitamin D status and any of the birth outcomes - small for gestational age (OR 1·00; 95 % CI 0·56, 1·79) and pre-term birth (OR 1·16; 95 % CI 0·64, 2·11) - growth outcomes - weight-for-age z-scores, length-for-age z-scores, circumferences of the head, abdomen and mid-arm at birth or postnatally - and adiposity outcomes - BMI, and skinfold thickness (triceps, biceps and subscapular) at birth or postnatally. Maternal vitamin D status in pregnancy did not influence infant birth outcomes, postnatal growth and adiposity outcomes in this cohort, perhaps due to the low prevalence (1·6 % of the cohort) of severe maternal vitamin D deficiency (defined as of <30·0 nmol/l) in our population.

Ways Forward in Preventing Severe Maternal Morbidity and Maternal Health Inequities: Conceptual Frameworks, Definitions, and Data, from a Population Health Perspective.

Studies of the association between maternal nutrition and birth outcomes have investigated differing nutrients, maternal socioeconomic conditions, and timing within the reproductive cycle; and have produced inconsistent results. We evaluated the association of preconceptional maternal dietary intake with birth outcomes among low socioeconomic status ethnic minority women in a high-income country. In this prospective cohort study, habitual preconceptional dietary intake was assessed among pregnant Bedouin Arab women in Israel (n = 384), using a short culturally specific, targeted food frequency questionnaire. Multiple nutrients (protein, lysine, calcium, iron, zinc, folate, omega-3 fatty acids) were evaluated simultaneously via a diet quality score derived from principal component analysis. Multivariable logistic regression was used to test associations between the diet quality score and a composite adverse birth outcomes variable, including preterm birth, low birth weight and small for gestational age. Sixty-nine women (18%) had adverse birth outcomes. Women with low preconceptional diet quality scores had low intakes of nutrient-rich plant foods, bioavailable micronutrients, and complete proteins. In multivariable analysis, a woman at the 10th percentile of the diet quality score had a 2.97 higher odds (95% CI 1.28-6.86) of an adverse birth outcome than a woman at the 90th percentile. Low diet quality during the preconceptional period was associated with adverse birth outcomes among low socioeconomic status minority women in a high-income country. The results have implications for the development of appropriate intervention strategies to prevent adverse birth outcomes, and the promotion of adequate nutrition throughout the child-bearing years.

BackgroundVitamin D has significant immunomodulatory effects on both adaptive and innate immune responses. Observational studies indicate that adults infected with HIV with low vitamin D status may be at increased risk of mortality, pulmonary tuberculosis, and HIV disease progression. Growing observational evidence also suggests that low vitamin D status in pregnancy may increase the risk of adverse birth and infant health outcomes. As a result, antiretroviral therapy (ART) adjunct vitamin D3 supplementation may improve the health of HIV-infected pregnant women and their children.Methods/designThe Trial of Vitamins-5 (ToV5) is an individually randomized, double-blind, placebo-controlled trial of maternal vitamin D3 (cholecalciferol) supplementation conducted among 2300 HIV-infected pregnant women receiving triple-drug ART under Option B+ in Dar es Salaam, Tanzania. HIV-infected pregnant women of 12–27 weeks gestation are randomized to either: 1) 3000 IU vitamin D3 taken daily from randomization in pregnancy until trial discharge at 12 months postpartum; or 2) a matching placebo regimen. Maternal participants are followed-up at monthly clinic visits during pregnancy, at delivery, and then with their children at monthly postpartum clinic visits. The primary efficacy outcomes of the trial are: 1) maternal HIV disease progression or death; 2) risk of small-for-gestational age (SGA) births; and 3) risk of infant stunting at 1 year of age. The primary safety outcome of the trial is incident maternal hypercalcemia. Secondary outcomes include a range of clinical and biological maternal and child health outcomes.DiscussionThe ToV5 will provide causal evidence on the effect of vitamin D3 supplementation on HIV progression and death, SGA births, and infant stunting at 1 year of age. The results of the trial are likely generalizable to HIV-infected pregnant women and their children in similar resource-limited settings utilizing the Option B+ approach.Trial registrationClinicalTrials.gov identifier: NCT02305927. Registered on 29 October 2014.

The interaction of pregnancy, substance use and mental illness on birthing outcomes in Australia

This paper proposes a framework for assessing the unmet needs of rape survivors during pregnancy based on the Sexual Assault Nurse Examiner (SANE) practice level theory and an empirical exploration of rape survivors’ health status in pregnancy via a secondary analysis. Our findings indicate that there may be unmet needs in pregnancy related to all five post-assault comprehensive care components: (1) physical care, (2) pregnancy prevention, (3) sexually transmitted infection screening, (4) psychological care, and (5) legal care. Rape history and its current impact on the survivor predicted somatic disorders, substance use, unwanted pregnancy, infections, posttraumatic stress disorder, and recent abuse.

The contribution of maternal working conditions to socio-economic inequalities in birth outcome

ObjectivesTo estimate the prevalence of maternal substance use problems during the first 1000 days of children’s lives, to inform planning and resourcing of antenatal screening and substance use in pregnancy...

To investigate the association of maternal circulating 25-hydroxyvitamin D3 [25(OH)D3] concentration with pregnancy and birth outcomes. Prospective cohort study. Four geographical areas of Spain, 2003-2008. Of 2382 mother-child pairs participating in the INfancia y Medio Ambiente (INMA) Project. Maternal circulating 25(OH)D3 concentration was measured in pregnancy (mean [SD] 13.5 [2.2] weeks of gestation). We tested associations of maternal 25(OH)D3 concentration with pregnancy and birth outcomes. Gestational diabetes mellitus (GDM), preterm delivery, caesarean section, fetal growth restriction (FGR) and small-for-gestational age (SGA), anthropometric birth outcomes including weight, length and head circumference (HC). Overall, 31.8% and 19.7% of women had vitamin D insufficiency [25(OH)D3 20-29.99 ng/ml] and deficiency [25(OH)D3 < 20 ng/ml], respectively. After adjustment, there was no association between maternal 25(OH)D3 concentration and risk of GDM or preterm delivery. Women with sufficient vitamin D [25(OH)D3 ≥ 30 ng/ml] had a decreased risk of caesarean section by obstructed labour compared with women with vitamin D deficiency [relative risk (RR) = 0.60, 95% CI 0.37, 0.97). Offspring of mothers with higher circulating 25(OH)D3 concentration tended to have smaller HC [coefficient (SE) per doubling concentration of 25(OH)D3, -0.10 (0.05), P = 0.038]. No significant associations were found for other birth outcomes. This study did not find any evidence of an association between vitamin D status in pregnancy and GDM, preterm delivery, FGR, SGA and anthropometric birth outcomes. Results suggest that sufficient circulating vitamin D concentration [25(OH)D3 ≥ 30 ng/ml] in pregnancy may reduce the risk of caesarean section by obstructed labour.

Accumulating Knowledge on the Social Determinants of Health and Infectious Disease

Maternal Dietary Glycemic and Insulinemic Indexes Are Not Associated with Birth Outcomes or Childhood Adiposity at 5 Years of Age in an Irish Cohort Study

Women's death due to complications of pregnancy and childbirth is still high. Maternity waiting homes are one of the strategies to reduce it. However, there is limited evidence on the effect of using maternity waiting homes on birth outcomes, particularly in this study area. Therefore, this study was aimed to estimate the effect of staying in maternity waiting homes use on maternal and perinatal birth outcomes and its challenges in the Amhara region, Northwest Ethiopia 2018. Institutional-based comparative cross-sectional study using both quantitative and qualitative approaches was conducted. Data were collected using structured questionnaire interviews, in-depth interview and chart reviews. Propensity score matching analysis was used to estimate the effect of maternity waiting homes use on birth outcomes. Propensity score matching analysis was used to match potential differences in background characteristics that affect pregnancy outcomes between comparison groups. We used thematic analysis for qualitative data. A total of 548 pregnant mothers (274 stayed in maternity waiting homes 274 did not stay) took part in this study. The proportion of adverse birth outcomes of mothers who stayed in maternity waiting homes were 15(5.5%) which is lower than those who didn't stay 35 (12.8%). After matching with baseline covariates, mean difference of adverse maternal birth outcomes, the difference between didn't use maternity waiting home and used was 10.4%, at (t = 3.78) at 5% level of significance. Similarly, the mean adverse perinatal birth outcomes difference between mothers who didn't use MWHs and used was 11% (t = 4.33). Maternity waiting home showed a significant positive effect on birth outcomes. Mothers who stayed in the maternity waiting homes had low adverse maternal and perinatal birth outcomes compared to non-users. Accommodations and quality health care services were the challenges mothers faced during their stay in the maternity waiting homes. Therefore, all concerned bodies should give attention accordingly to maternity waiting home services to reduce adverse birth outcomes through the strengthening of the quality of health care provided.

Background: Exclusive breastfeeding is recomended food for infants until the age of 6 months. After 6 months years old a complementary food is recomended until 2 years of age. However, percent of mothers practicing exclusive breastfeeeding is still low. This study aimed to determine factors associated with exclusive breastfeeding among mothers in Banjarmasin, South Kalimantan. Subjects and Method: This was a quantitative-qualitative study conducted in Banjarmasin, South Kalimantan from June to December 2015. A sample of 258 lactating mothers, consisting of 136 mothers who exclusively breastfed and 122 mothers who did not exclusively breastfeed, were selected for this study by random sampling. The dependent variable was exclusive breastfeeding. The independent variables were maternal age, education, knowledge of exclusive breastfeeding, maternal health condition, maternal work status, and family support. Data were collected by pre-tested questionnaire and interview. Data were analyzed by logistic regression. Results: Low maternal education (OR = 0.54; 95% CI = 0.87 to 1.82; p = 0.005), low maternal knowledge (OR = 0.32; 95% CI =; p = 0.001), poor maternal health condition (OR = 0.23 , 95% CI = 0.08 to 3.93, p = 0.082), and low family support (OR = 0.93; 95% CI = 0.02 to 8.93; p = 0.328) were associated with decreased chance of exclusive breastfeeding. Maternal age 20-29 years (OR = 1.76; 95% CI = 0.18 to 6.74; p = 0.062) and housewife (OR = 1.24; 95% CI = 1.00 to 8.29; p = 0.123) were associated with increased chance of exclusive breastfeeding. Qualitative study showed that lack of maternal knowledge on the utility of exclusive breastfeeding was a strong predictor for not practicing exclusive breastfeeding. Most of the mothers interviewed believed that providing food in addition to breastmilk could accelerate the growth of their children. Conclusion: Low maternal education, low maternal knowledge, poor maternal health condition, and low family support are associated with decreased chance of exclusive breastfeeding. Maternal age 20-29 years and housewife are associated with increased chance of exclusive breastfeeding. Keywords: exclusive breastfeeding, age, education, knowledge, maternal health condition, maternal working status, family support