Frequency Of Mothers Research Articles

Assessment of vitamin B12 and homocysteine levels in pregnant women admitted for delivery and cord blood samples of their newborn babies: a multicenter study.

Vitamin B12, an indispensable micronutrient, is pivotal in numerous physiological processes, with particular significance during pregnancy and fetal development. The increasing adoption of vegetarian diets and the economic challenges associated with accessing animal-based food sources contribute to the prevalence of vitamin B12 deficiency. This study aims to examine the levels of vitamin B12 and homocysteine in pregnant women upon admission for delivery and to analyze corresponding cord blood samples from their newborn infants in a substantial sample within the Istanbul metropolitan area. This cross-sectional multicenter study included women aged ≥16 years admitted for delivery and their newborns ≥34 weeks. The demographic data and the results of complete blood counts within the previous 24 hours before birth were recorded. Vitamin B12 and homocysteine levels were measured in maternal and cord blood samples. The study parameters were compared between the groups based on the mothers' and babies' homocysteine and vitamin B12 levels. The study included 832 pregnant women and 832 neonates. Anemia affected 36% of pregnant women, with a higher frequency in mothers with vitamin B12 deficiency. Seventy-eight mothers and 48.9% of neonates showed Vitamin B12 levels below 200 pg/mL, while elevated homocysteine levels were observed in 30% of mothers and 26% of neonates. Maternal vitamin B12 deficiency was significantly correlated with cord blood B12 deficiency and elevated homocysteine. The median cord blood vitamin B12 level was inversely correlated with the number of previous pregnancies. Vitamin B12 deficiency is extremely common in pregnant women before delivery, significantly correlating to cord blood homocysteine and vitamin B12 levels. However, homocysteine alone is not a reliable marker for maternal vitamin B12 status. Implementing strategies to detect vitamin B12 deficiency and supplying adequate vitamin B12 supplementation during pregnancy holds the potential to enhance maternal and neonatal health in Türkiye.

Maternal Mobile Device Use and Mealtime Interactions With Children.

This study examined (1) whether different types of mobile device use are associated with quantity/quality of parent-child interactions and (2) moment-to-moment changes in quantity/quality of parent-child interactions when devices are used. In 47 videorecorded home mealtimes conducted in 2011 to 2013, we conducted detailed coding of maternal device use (talking, texting/scrolling, having device on table), frequency of mother and child verbalizations, child bids for attention, and maternal response to bids (contingent, no response, negative response) in 5-second intervals. We examined between-mother differences in parent-child interaction variables for a 10-percentage point increase in each type of device use comparisons using negative binomial or logistic regression. We then compared intervals when there was active mobile device use to nonuse intervals using generalized estimating equation logistic regression, predicting the odds of each parent-child interaction variable. Mothers averaged 29.8 years (SD 6.10), child age 5.97 years (SD 0.56), and 55% had completed at least some college. Higher percentage of time spent texting/scrolling was associated with a lower rate of maternal verbalization (adjusted rate ratio 0.89 [95% confidence interval, 0.84-0.95]) and contingent response (adjusted rate ratio 0.92 [0.84-1.00]) and higher odds of nonresponse (adjusted odds ratio 1.13 [1.04-1.22]). In each 5-second interval of active device use, there was decreased odds of maternal verbalizations (adjusted odds ratio 0.48 [0.34-0.69]), child verbalizations (0.62 [0.44-0.88]), contingent response (0.45 [0.28-0.74]), and higher odds of maternal nonresponse (2.36 [1.40-4.00]). These results demonstrate decreased parent-child verbal interaction and lower parent responsiveness during mobile device use, particularly with texting and scrolling.

Water, sanitation, and hygiene (WASH) practices of mothers and the health status of under-five children: a study from Rural Nayagarh, Odisha

ABSTRACT The objective of this study was to assess water, sanitation, and hygiene (WASH) practices of mothers with under-five children in rural pockets of the Nayagarh district, Odisha and examine how those practices are associated with the health status of children. A cross-sectional household survey was carried out with 370 participants having under-five children in rural pockets of the Nayagarh district, Odisha. A multistage sampling strategy was adopted. Participants were interviewed using a pre-tested structured schedule. Household information was analysed using descriptive statistics; logistic regression models were used to determine the association between mothers’ handwashing practices and the health status of their under-five children. Nearly 74.9% of the households in the sample earned less than 40,000 Indian rupees ($481) annually. Nearly 73% of mothers threw the childrens' faecal waste into drains and open garbage. Diarrhoea was strongly associated with mothers who did not encourage their children to wash their hands (p = 0.007). The frequency of mothers' handwashing before feeding was associated with childrens' episodes of fever, common cold, and cough (p = 0.045). A set of targeted interventions, such as health education and socio-behavioural changes, is needed to address significant WASH factors associated with the health of under-five children in rural areas.

Role of maternal non-transport pro-environmental behaviors in adolescents’ travel-to-school mode choices

This study investigates in UK context the relationship between adolescents’ choice of sustainable transport modes (e.g. active transport like walking or cycling and public transport like buses or subways) for their journey to school and maternal non-transport pro-environmental behaviors, such as energy conservation and environmentally friendly purchases, as well as its temporal changes. Data from waves 4 and 10 of the UK Understanding Society survey were separately analyzed using multinomial logistic regression to explore the relationship between frequency of mothers’ non-transport pro-environmental behaviors and adolescents’ sustainable transport to school. Additionally, to understand changes in the strength of this relationship over time, a regression analysis was conducted examining the interaction of mothers’ non-transport pro-environmental behaviors with the survey year. Findings indicate substantial correlations between an array of variables including adolescents’ age, ethnicity, mothers’ occupational and transport behaviors, the number of cars owned by the household, and the nature of residence (urban vs rural), with the adolescents’ active or public transport choice to school, consistently across both waves. As the primary focus of the study, a positive relationship between mothers’ non-transport pro-environmental behaviors and adolescents’ public transport to school is found, although the strength of this relationship declined over time. Importantly, more easily observable mothers’ non-transport pro-environmental behaviors holds a stronger strength of correlation with adolescents’ use of public transport to school, compared to maternal psychological factors like pro-environmental attitudes. Hence, encouraging a range of sustainable behaviors among mothers is crucial to promote adolescents’ public transport to school.

Intake of anticonvulsant drugs by women with epilepsy during pregnancy and breastfeeding: advantages and disadvantages

Anti-epileptic drugs (AED) are being widely used in neurological practice. These are being prescribed as standard treatment not only of epilepsy, but also in various non-epileptic conditions, such as psychic illnesses and chronic pain. The main issue for women with epilepsy and their doctors during the AED administration is child and mother’s safety during pregnancy and breastfeeding. Anti-epileptic treatment during these periods could have an unfavourable impact on the frequency of mother’s seizures and child’s psychomotor development. Breastfeeding-related risks during the AED administration remain theoretical, bearing in mind the insufficient data from the limited previously undertaken research. In view of the established benefits from breastfeeding for babies’ long-term health in the general population, breastfeeding is to be promoted, with discretion on whether this should be balanced, individual, with monitoring of AED concentration in mother’s milk and mother and breastfed child’s serum.

Speaking partners’ talk in transitions between symbols in conversations that use speech-output technologies

Aided conversations differ from spoken ones in their transitions between turns and symbols because seeking and choosing symbols takes more time than speaking words naturally. This study adopted the concepts and principles of conversation analysis (CA) to analyze the transitions between symbols during the construction of aided turns. The data was from the spontaneous conversations at home between mothers and four males (sons) who used speech-output technologies. The analyses compared the durations of transitions between turns and symbols and frequency of mothers’ talk during the transitions. The mothers most often remained silent during the symbol-transitions, but when they talked, their speech was inspired by the current context and was not coincidental. When the mothers spoke during the symbol-transitions, their sons either continued or paused constructing their turn. Despite the effect on the progress of conversations, the participants did not orient to these expanded aided turns as challenging. The expansions manifested (a) in parallel (b) side by side with the aided turn, and (c) as a part of the ongoing aided turn. Analyzing the structural characteristics of aided conversations deepens our understanding of theoretical concepts, offers strategies to guide aided communicators and their partners, and helps to develop augmentative and alternative communication technologies that promote interactive communication.

Frequency of hearing loss in children with cerebral palsy and parents’ perception regarding their child’s hearing.

Objective: To determine frequency of hearing loss in cerebral palsy (CP) children and perception of child’s hearing and brain evoked response auditory (BERA) / brainstem auditory evoked potential (BAEP) results in CP patients. Study Design: Cross-sectional study. Setting: Department of Pediatric Neurology, Liaquat National Hospital, Karachi. Period: January 2022 to December 2022. Material & Methods: The parents of all the CP children having cerebral palsy and who were nor assessed for hearing screening at birth (newborn hearing screening) were included. In child neurology clinic, parents were interviewed for the perception of the hearing of the child. Parental perception, CP type and the BERA results were recorded. Results: Total 102 patients were studied with median age of 27.9 (IQR= 17 – 48) months. Majority of the patients were normally delivered (n=59, 57.8%). Nearly quarter of them underwent neonatal screening (n=22, 21.6%). Majority of mothers (n=85, 83.3%) and father (n=80, 78.4%) had perception of hearing. BERA test was normal for 44 (43.1%) children. Age was significantly higher among patients with abnormal results. Frequency mothers’ perception of normal hearing was higher in abnormal BERA result. Frequency of difficult speech was higher in patients with abnormal BERA results. Conclusion: The frequency of hearing loss was high among children with CP. Frequency of mothers’ perception of their CP child’s normal hearing was higher when compared to the father’s perception.

Impact of Maternal Fish Consumption on Serum Docosahexaenoic Acid (DHA) Levels in Breastfed Infants: A Cross-Sectional Study of a Randomized Clinical Trial in Japan.

Docosahexaenoic acid (DHA), an essential n-3 long-chain polyunsaturated fatty acid (LCPUFA) abundant in fish, is crucial for infant brain development. We investigated the associations between maternal dietary habits, infant feeding patterns, and serum levels of DHA and other LCPUFAs in infants aged 5-6 months in Japan, where fish consumption is high. This cross-sectional study used serum samples from 268 infants enrolled in a randomized clinical trial. The frequency of mothers' consumption of 38 food items and infant feeding patterns were prospectively surveyed. Cow's milk formula (CMF) supplemented with 15.9% linolenic acid, 1.6% α-linolenic acid, 0.40% DHA, and 0.27% arachidonic acid was used. Significant positive associations with infants' serum DHA levels were found for "Blue-back fish" (rho = 0.24; p = 0.0001) and "White fish" (rho = 0.25, p = 0.0001). The combined variable "Blue-White fish" was found to be significantly associated with higher serum DHA levels in infants (rho = 0.29, p < 0.0001). Predominantly breastfed infants had significantly higher serum DHA levels than those fed more CMF (rho = 0.32, p < 0.0001). After multivariate analysis, "Blue-White fish" and "Feeding patterns" remained significantly and independently associated with serum DHA levels. These findings suggest that frequent consumption of "Blue-back fish" and/or "White fish" by lactating mothers, along with prioritizing breastfeeding over DHA-supplemented CMF, might effectively increase infants' serum DHA levels.

Vocal Turn-taking between Mothers and Their Toddlers with Cochlear Implants

Objectives: This study attempted to identify the quantitative characteristics that appear in vocal turn-taking between mothers and toddlers with cochlear implants (CIs) and to examine the relationships between variables of vocal turn-taking and the language development of the CI and typical hearing (TH) group.Methods: Ten pairs of mothers and toddlers with CIs and 12 pairs of mothers and toddlers with TH participated in this study. Their interactions during a 20-minute free-play task were recorded using a digital recorder. Their vocalizations were coded for vocalization, switching pause, turn-taking block, and overlap using the Praat program.Results: Toddlers with TH took more vocal turns with their mothers than did toddlers with CIs. Toddlers with TH produced significantly more vocalizations than toddlers with CIs; however, there was not a significant difference in the frequency of mothers’ vocalizations between the two groups. Mothers in the TH group produced a significantly highter proportion of vocalizations in turn-taking than mothers in the CI group; however, there was not a significant difference in the proportion of toddlers’ vocalizations between the two groups. Language scores were significantly correlated with the frequency of vocal turn-taking, toddlers’ vocalizations, and mothers’ vocalizations in the CI group.Conclusion: These results suggests that toddlers with CIs are not active partners in vocal turn-taking at an earlier age and that mothers are likely to adjust vocal turn-taking formats to their toddlers with CIs. The variables of vocal turn-taking can be a sensitive index to predict language skills in the CI group.

Frequency Of Spinal Defects in Fetuses with Ventriculomegaly

Fetal ventriculomegaly (VM) is a dilation of the lateral ventricle. Different patients have different etiologies for fetal ventriculomegaly, which can be idiopathic, structural, or chromosomal. A measurement of 10–15 mm is commonly referred to as mild ventriculomegaly, while measurements of 15–20 and &gt;20 mm and above are defined as moderate and severe ventriculomegaly. Objective: To find the frequency of spinal defects (SD) in fetuses with ventriculomegaly (VM). Methods: It was a cross-sectional analytical study which included 103 pregnant ladies who had evidence of ventriculomegaly visited multiple centers during research period. Convenient sampling method was used. The presence of ventriculomegaly was confirmed using transabdominal probe with frequency 3-5 MHz. Frequency was calculated and crosstabs were made using SPSS version 21.0. Results: Among 103 pregnant patients, frequency of fetal spinal defects was 25.2%. Frequency of ventriculomegaly was as follow: mild ventriculomegaly 43.7%, moderate ventriculomegaly 31.2%, and severe ventriculomegaly 25.2%. Among 103 patients, 25.2% patients had AFI greater than 21. Frequency of mother's H/O any fetal spinal defects in their previous pregnancies was 15.5%. Conclusions: The study concluded that frequency of spinal defects in fetuses with ventriculomegaly was 25.2% and spinal defects occur in those patients who had severe ventriculomegaly (&gt;20mm) and had AFI greater than 25

Maternal mobile phone use during mother-child interactions interferes with the process of establishing joint attention.

Parental mobile device use while parenting has been associated with reduced parental responsiveness and increased negative affect among children. However, it remains unclear whether it can interfere with the process of acquiring social communication skills. Thus, this study sought to experimentally examine whether maternal mobile phone use while interacting with the child has an immediate effect on the frequency of mothers' and infants' joint attention (JA) behaviors, the likelihood that these behaviors will lead to JA episodes, and the duration of established JA episodes. Participants were a community sample of 114 (Mage = 11.36 months; 50% male) Israeli typically developing infants, in which most mothers were highly educated and living in two-parent families. Mother-infant dyads completed a modified still-face paradigm and were randomly assigned to one of three experimental conditions during the still-face phase: (a) mobile phone disruptions, (b) social disruptions, and (c) undisrupted play. Mother-infant interactions were coded for frequency of JA behaviors and duration of JA episodes. In dyads assigned to the mobile phone disruptions condition, infants produced more JA initiations, mothers were less likely to contingently respond to infant initiations, JA behaviors were less likely to result in established JA, and JA episodes were shorter compared to dyads in the two control conditions and the baseline free play phase. Findings suggest that maternal mobile phone use during face-to-face interactions with the infant can disrupt the process of establishing JA in ongoing mother-child interactions. Possible implications from this line of work for family digital media use are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A double-edged sword: parental care increases risk of offspring infection by a maternally vectored parasite.

Parental care can protect offspring from predators but can also create opportunities for parents to vector parasites to their offspring. We hypothesized that the risk of infection by maternally vectored parasites would increase with the frequency of mother–offspring contact. Ammophila spp. wasps (Hymenoptera: Sphecidae) build nests in which they rear a single offspring. Ammophila species exhibit varied offspring provisioning behaviours: some species enter the nest once to provision a single, large caterpillar, whereas others enter the nest repeatedly to provision with many smaller caterpillars. We hypothesized that each nest visit increases the risk of offspring parasitism by Paraxenos lugubris (Strepsiptera: Xenidae), whose infectious stages ride on the mother wasp (phoresy) to reach the vulnerable Ammophila offspring. We quantified parasitism risk by external examination of museum-curated Ammophila specimens—the anterior portion of P. lugubris protrudes between the adult host's abdominal sclerites and reflects infection during the larval stage. As predicted, Ammophila species that receive larger numbers of provisions incur greater risks of parasitism, with nest provisioning behaviour explaining ca 90% of the interspecific variation in mean parasitism. These findings demonstrate that parental care can augment, rather than reduce, the risk of parasite transmission to offspring.

An acute dose of intranasal oxytocin rapidly increases maternal communication and maintains maternal care in primiparous postpartum California mice.

Maternal-offspring communication and care are essential for offspring survival. Oxytocin (OXT) is known for its role in initiation of maternal care, but whether OXT can rapidly influence maternal behavior or ultrasonic vocalizations (USVs; above 50 kHz) has not been examined. To test for rapid effects of OXT, California mouse mothers were administered an acute intranasal (IN) dose of OXT (0.8 IU/kg) or saline followed by a separation test with three phases: habituation with pups in a new testing chamber, separation via a wire mesh, and finally reunion with pups. We measured maternal care, maternal USVs, and pup USVs. In mothers, we primarily observed simple sweep USVs, a short downward sweeping call around 50 kHz, and in pups we only observed pup whines, a long call with multiple harmonics ranging from 20 kHz to 50 kHz. We found that IN OXT rapidly and selectively enhanced the normal increase in maternal simple sweep USVs when mothers had physical access to pups (habituation and reunion), but not when mothers were physically separated from pups. Frequency of mothers' and pups' USVs were correlated upon reunion, but IN OXT did not influence this correlation. Finally, mothers given IN OXT showed more efficient pup retrieval/carrying and greater total maternal care upon reunion. Behavioral changes were specific to maternal behaviors (e.g. retrievals) as mothers given IN OXT did not differ from controls in stress-related behaviors (e.g. freezing). Overall, these findings highlight the rapid effects and context-dependent effect a single treatment with IN OXT has on both maternal USV production and offspring care.

In utero exposure to endogenous maternal polyclonal anti-Caspr2 antibody leads to behavioral abnormalities resembling autism spectrum disorder in male mice

The concept that exposure in utero to maternal anti-brain antibodies contributes to the development of autism spectrum disorders (ASD) has been entertained for over a decade. We determined that antibodies targeting Caspr2 are present at high frequency in mothers with brain-reactive serology and a child with ASD, and further demonstrated that exposure in utero to a monoclonal anti-Caspr2 antibody, derived from a mother of an ASD child, led to an-ASD like phenotype in male offspring. Now we propose a new model to study the effects of in utero exposure to anti-Caspr2 antibody. Dams immunized with the extracellular portion of Caspr2 express anti-Caspr2 antibodies throughout gestation to better mimic the human condition. Male but not female mice born to dams harboring polyclonal anti-Caspr2 antibodies showed abnormal cortical development, decreased dendritic complexity of excitatory neurons and reduced numbers of inhibitory neurons in the hippocampus, as well as repetitive behaviors and impairments in novelty interest in the social preference test as adults. These data supporting the pathogenicity of anti-Caspr2 antibodies are consistent with the concept that anti-brain antibodies present in women during gestation can alter fetal brain development, and confirm that males are peculiarly susceptible.

In utero exposure to endogenous maternal polyclonal anti-Caspr2 antibody leads to an autism-like phenotype in male mice

Abstract Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder with a complex etiology. A strong sex bias has been observed in ASD with boys being four times more likely to be diagnosed than girls. The maternal immune system has been repeatedly implicated in the etiology of ASD. Maternal infection with fever during pregnancy has been linked to ASD. Increased levels of maternal cytokines and chemokines during gestation, including interleukin 6, have been associated with ASD in children with intellectual disabilities. Studies, including our own, have consistently supported the hypothesis that maternal brain-reactive antibodies can predispose to ASD by affecting the developing brain during a critical period. We have previously demonstrated that antibodies targeting the neuronal protein Caspr2 are present at high frequency in mothers with brain-reactive serology and a ASD child. Furthermore, male mice but not female mice exposed in utero to a monoclonal anti-Caspr2 antibody cloned from a mother of a child with ASD, develop an ASD -like phenotype. In the present study we use a new model in which female mice are immunized with the extracellular portion of Caspr2, and therefore harbor anti-Caspr2 antibodies throughout gestation to mimic the human condition. Male mice born to dams harboring polyclonal anti-Caspr2 antibodies exhibit abnormal cortical development, decreased dendritic complexity of excitatory neurons and reduced numbers of inhibitory neurons in the hippocampus, as well as repetitive behaviors and impairments in social interactions as adults. These studies will increase our understanding of the triggers of neurodevelopmental impairment and possibly suggest novel approaches to protecting the fetal brain.

Mothers' Healthcare Autonomy, Maternal-Health Utilization and Healthcare for Children under-3 Years: Analysis of the Nigeria DHS Data (2008-2018).

This study was designed to simultaneously examine if mothers’ personal healthcare autonomy within the household, and the level of their maternal-healthcare utilization, translates into better preventive (complete immunization) and curative (treatments for diarrhoea, fever and acute respiratory infection) efforts on morbidities in child healthcare. We analysed data pooled from three consecutive waves of the Nigeria Demographic and Health Survey: the surveys of 2008, 2013 and 2018. Using a multilevel logistic regression, we estimated the odds ratio for each of the outcome variables while adjusting for covariates. Findings revealed that mothers’ health autonomy is positively associated with child immunization and treatment of morbidities (except diarrhoea), a relationship moderated by the frequency of mothers’ exposure to media. Additionally, mothers’ healthcare utilization is positively associated with complete immunization, and all forms of morbidity treatment (except diarrhoea). Although the relationship between mothers’ healthcare-utilization and child immunization is not dependent on family wealth, however, the relationship between mothers’ healthcare utilization and treatment of morbidity is dependent. Policy effort should be geared towards stimulating mothers to seek appropriate and timely child healthcare and future studies could consider looking into the mediating role of paternal support in this relationship.

The relationship between parental religiosity and school age children's dietary behavior in Ningxia Province, China: A cross-sectional study.

Studies have shown parental religious involvement was associated with better health behaviors of their children. However, the relationship between parental religiosity and child dietary behaviors remains unclear. This study aimed to examine the relationship between parental religious involvement and the dietary behaviors of school-aged children in mainland, China. Participants were selected from a northwest province of China using a multi-stage sampling process from July 2017 to October 2017. The frequency of parental religious activities and the importance of religion in life, along with the dietary behaviors of children, were collected using a questionnaire. Dietary pattern analysis coupled with multivariable linear regression was employed to test the association between parental religious involvement and children's dietary behavior. The regression model indicated no significant relationship between parental religious behaviors and children's dietary behaviors in the overall sample. However, the frequency of mother's religious attendance was inversely related to children's consumption of vegetables (β = -0.40, P < 0.05) in the Hui subsample (vs. Han) when stratifying analyses by ethnicity. These findings suggest among those of Hui ethnicity, parental religious involvement may impact children's dietary behavior in a way that may affect their future health habits.

Delayed onset of lactogenesis and reduced breastfeeding frequency in mothers who give birth by caesarean section

AbstractLactogenesis stage II, also known as when a mother's milk “comes in”, is characterised by copious milk production. Delayed lactogenesis II, when onset occurs after 72 hours post-partum, has been linked to early breastfeeding cessation. It has been suggested that caesarean section is a risk factor for late onset of lactogenesis II. It is unknown why lactogenesis II may be delayed in caesarean section but there are several potential reasons such as volume of blood loss, maternal stress, delayed breastfeeding initiation and difficulties with mobility and positioning. Analysis of timing of lactogenesis and breastfeeding frequency was carried out on data from the PROMESA and IMPRINT studies, which were looking at the supplementation of breast milk with a probiotic Bifidobacterium infantis. IMPRINT was carried out in California and enrolled eighty women prior to birth or before postnatal day 4. The PROMESA study in the UK only recruited women who were booked for elective caesarean sections, and also enrolled eighty mother-baby dyads. As part of both studies mothers filled out a variety of surveys and daily logs, including a daily feeding log, along with self-reported lactogenesis. Using logistic regression, we looked at whether mode of birth (spontaneous vaginal delivery, emergency and elective caesarean section) was associated with the timing of onset of lactogenesis, and linear regression to look at the difference in breastfeeding frequency between modes of birth. Mode of birth was significantly associated with delayed onset of lactogenesis &gt; 3 days (OR 3.38, 95% CI 2.48–4.61). There was also a reduced frequency of breastfeeding in the first week post-partum in mother-baby dyads who underwent an elective caesarean section. These findings suggest that mothers who give birth by elective caesarean section may need additional support with breastfeeding in the early days post-partum, as well as ongoing support long-term to reduce the likelihood of early cessation of breastfeeding.

Effect of community-based distribution of misoprostol on facility delivery: a scoping review

IntroductionCommunity distribution of misoprostol to pregnant women in advance of labor is one of the compelling strategies for preventing postpartum hemorrhage. Concerns have been reported that misoprostol distribution could reduce facility delivery or lead to misuse of the medication. This scoping review was conducted to synthesize the evidence on the effect of community-based misoprostol distribution on rates of facility delivery, and to assess the frequency of mothers taking distributed misoprostol before delivery, and any harmful outcomes of such misuse.MethodsWe included peer-reviewed articles on misoprostol implementation from PubMed, Cochrane Review Library, Popline, and Google Scholars. Narrative synthesis was used to analyze and interpret the findings, in which quantitative and qualitative syntheses are integrated.ResultsThree qualitative studies, seven observational studies, and four experimental or quasi-experimental studies were included in this study. All before-after household surveys reported increased delivery coverage after the intervention: ranging from 4 to 46 percentage points at the end of the intervention when compared to the baseline. The pooled analysis of experimental and quasi-experimental studies involving 7564 women from four studies revealed that there was no significant difference in rates of facility delivery among the misoprostol and control groups [OR 1.011; 95% CI: 0.906–1.129]. A qualitative study among health professionals also indicated that community distribution of misoprostol for the prevention of postpartum hemorrhage is acceptable to community members and stakeholders and it is a feasible interim solution until access to facility birth increases.In the community-based distribution of misoprostol programs, self-administration of misoprostol by pregnant women before delivery was reported in less than 2% of women, among seven studies involving 11,108 mothers. Evidence also shows that most women who used misoprostol pills, used them as instructed. No adverse outcomes from misuse in either of the studies reviewed.ConclusionsThe claim that community-based distribution of misoprostol would divert women who would have otherwise had institutional deliveries to have home deliveries and promote misuse of the medication are not supported with evidence. Therefore, community-based distribution of misoprostol can be an appropriate strategy for reducing maternal deaths which occur due to postpartum hemorrhages, especially in resource-limited settings.

HLA-B*14 allele predicts HIV-1 mother-to-child-transmission, in Salvador, Brazil

BackgroundClass I human leukocyte antigens, especially the molecules encoded at the B locus (HLA-B), are associated with AIDS progression risk. Different groups of HLA-B alleles have been associated to a protective effect or increasing susceptibility to HIV infection and are expressed from the earliest stages of gestation. ObjectiveThe aim of this study was to evaluate which variants of HLA-B are associated with the risk of HIV vertical transmission in infected pregnant women and in their offspring, in a referral center in Salvador Bahia. MethodsWe performed HLA-B genotyping in 52 HIV-infected mothers and their children exposed to HIV-1 during pregnancy (N=65) in Salvador, Brazil. We compared the HLA-B alleles frequency in mothers, uninfected and infected children, according to the use of antiretroviral prophylaxis. ResultsAbsence of antiretroviral antenatal and postnatal prophylaxis was significantly associated with vertical transmission of HIV-1 (p=<0.01, and p=<0.01 respectively). Frequency of HLA-B*14 (29.2%, p=0.002), HLA-B*18 (16.7%, p=0.04) or HLA-B*14:1 (20.8%, p=0.01) alleles subgroups were significantly higher in HIV-1 infected children and persisted (HLA-B*14, p=0.04) even after adjusting for use of antiretroviral prophylaxis. No significant difference in expression of HLA-B alleles was observed among mothers who transmitted the virus compared to those who did not. ConclusionsExpression of HLA-B*14 allele in children exposed to HIV-1 is predictive of vertical transmission and reinforces the important role of genetics in mother-to-child transmission.