Gravis Research Articles

The impact of major congenital anomalies on obstetric outcomes in the United Arab Emirates: the Mutaba’ah Study

Major congenital anomalies (MCAs) are a public health concern. However, studies on obstetric outcomes in pregnancies complicated by MCAs are scarce, emphasizing the need for research to enhance management strategies. This study aimed to investigate the impact of MCAs on fetal presentation and delivery mode in the United Arab Emirates. The analysis was based on a cohort of single live births in the Mutaba’ah study (2017–2023). Univariable and multivariable regression models assessed the associations between MCAs and obstetric outcomes, adjusting for maternal and neonatal characteristics. For any and single MCAs, significant associations with breech presentation were detected in women below 35 years (AOR = 2.7, 95% CI: 1.5-5.0; AOR = 2.5, 95% CI: 1.3–4.8) and among term deliveries (AOR = 2.5, 95% CI: 1.4–4.3; AOR = 2.4, 95% CI: 1.3–4.3). These associations remained significant in young (< 35 years) multiparous and older (≥ 35 years) nulliparous, as well as among term multiparous and preterm nulliparous women. The association with cesarean delivery was significant among multiparous below 35 years, where mothers of neonates with any MCAs had twice the odds of cesarean delivery (AOR = 2.1, 95% CI: 1.3–3.4). This study revealed a significant association between MCAs and the risk of breech presentation and cesarean delivery, varying by maternal age, gestational age, and parity. These findings underscore the need for early detection of MCAs in pregnancy, as this may help avoid obstetric complications. However, addressing the risk factors for MCAs and promoting a multidisciplinary approach would lead to even better outcomes for both mother and newborn.

Prevalence of adolescent pregnancy and evaluation of pregnancy outcomes: a retrospective study.

According to the World Health Organization, adolescent pregnancy is defined as pregnancies of women aged 19 and below. The study aims to analyze the rates of adolescent pregnancies and maternal and fetal outcomes among births within the hospital and compare them with adult pregnancies. The study is conducted retrospectively in one of Turkey's socio-economically underdeveloped provinces. The study comprises 16,985 women: 1719 adolescents and 15,266 adults who gave birth in the hospital between January 1, 2020, and December 31, 2023. All data were recorded in the SPSS 28.0 program, and the Kolmogorov-Smirnov test, Chi-Square test, ANOVA, and Independent Simple T-test were applied to analyze the data. In the study, the adolescent pregnancy rate is found to be 10,1%. The mean maternal age (p = 0.000), gravida (p = 0.000), parity (p = 0.000), and number of abortions (p = 0.002) are significantly higher in the adult group. No difference is found between the groups in terms of gestational age (p = 0.067). Newborn birth weight was significantly higher in the adult group (p = 0.000). Cesarean section rates are higher in the adult group (p = 0.001). No difference is found in terms of stillbirth rates. No difference is found between the groups in terms of pre-eclampsia (p = 0.792). No difference is found between the groups in terms of preterm birth (p = 0.664). In conclusion, it came out that, according to the results of the study, the rates of premature birth, pre-eclampsia, and stillbirth in adolescents and the first and fifth-minute Apgar scores are similar to adults. However, newborn birth weights are lower in the babies of adolescent pregnant women. In addition, cesarean section rates are higher in the adult group.

Occupational noise exposure and maternal pregnancy complications: register-based cohort from urban areas in four Nordic countries

ObjectiveTo assess the role of occupational noise exposure on pregnancy complications in urban Nordic populations.MethodsA study population covering five metropolitan areas in Denmark, Finland, Norway and Sweden was generated using...

Association of First-Trimester Low PAPP-A Levels (&lt;0.2 MoM) with Maternal and Fetal Outcomes

Background and Aim: First-trimester screening is routinely performed globally to detect chromosomal abnormalities using non-invasive methods such as nuchal translucency (NT) measurements, pregnancy-associated plasma protein A (PAPP-A), and β-human chorionic gonadotropin (β-hCG). Recent studies have highlighted that low PAPP-A levels may be associated with adverse pregnancy outcomes, including pre-eclampsia, intrauterine growth restriction (IUGR), and pre-term delivery. Generally, low PAPP-A is defined as below 0.4 multiples of the median (MoM) or under the 5th percentile. However, extremely low PAPP-A, defined as levels below 0.2 MoM or under the 1st percentile, significantly increases the risk of adverse outcomes. This category has received less attention in research. Our study aims to investigate the correlation between PAPP-A levels below 0.2 MoM and adverse pregnancy outcomes. Materials and Methods: A retrospective cross-sectional study was conducted on 10,256 pregnant women who underwent first-trimester screening at Imam Khomeini Hospital in Ahvaz between January 2010 and April 2024. PAPP-A and β-hCG levels were measured, and factors such as maternal age, weight, parity, and abortion history were assessed. Data were obtained using the Fetal Medicine Foundation (FMF) software and medical records. Statistical analysis was performed using SPSS version 26. Results: Out of 10,256 pregnancies, 6,040 (6.4%) had PAPP-A levels below the 5th percentile, while 45 women had PAPP-A levels below 0.2 MoM. The average age of these women was 30.4 ± 4.812 years. Among those with PAPP-A &lt; 0.2 MoM, 2.2% had trisomy 21, 6.7% had IUGR, 26.7% experienced gestational hypertension, and 15.6% developed pre-eclampsia. Trisomies 13 and 18 were not observed in the study population. Conclusions: Pregnant women with PAPP-A levels below 0.2 MoM showed increased incidences of trisomy 21, pre-eclampsia, gestational hypertension, and IUGR. Although low PAPP-A appears to contribute to both maternal and fetal complications, it cannot be used independently to predict adverse pregnancy outcomes. Further large-scale studies are required to better understand the implications of extremely low PAPP-A on pregnancy outcomes.

Risk factors of the appearance of anencephaly in Tunisia.

Anencephaly is a serious developmental defect of the central nervous system in which the brain and cranial vault are grossly malformed. The cerebrum and cerebellum are reduced or absent, but the hindbrain is present. Anencephaly is a part of the neural tube defect spectrum. This defect results when the neural tube fails to close during the third to fourth weeks of development, leading to fetal loss, stillbirth, or neonatal death. To find out probable principal risk factors for the appearance of anencephaly. This study was conducted to compare between pregnancies affected by anencephaly in 2002-2011 with those notified in the period 1991-2001. Statistical analysis was undertaken using chi-squared tests. Results had shown that anencephaly fetuses with a weight less than 1500 g were significantly higher in the period 2002-2011 than in 1991-2001 (P=0.003; OR= 4.32; CI= 1.62-11.53). Anencephaly cases aged more than 20 weeks of gestation (WG) were statistically elevated than cases aged less than 20 WG (P= 0.003). Maternal parity was associated with the appearance of anencephaly, where uni- or multiparous cases mothers were more likely to have an offspring with anencephaly than nulliparous mothers. Consanguinity presented a significant risk factor for the occurrence of anencephaly (P= 0.003). A logistic regression was run to examine the impact of several variables, only the maternal age was statistically significant. This study clarified fields where efforts should be intensified, and surveillance data developed to prevent this malformation.

Risk of adverse birth outcomes and birth defects among women living with HIV on antiretroviral therapy and HIV-negative women in Uganda, 2015-2021.

We assessed the risk of adverse pregnancy and birth outcomes and birth defects among women living with HIV (WLHIV) on antiretroviral therapy (ART) and HIV-negative women. We analyzed data on live births, stillbirths, and spontaneous abortions during 2015-2021 from a hospital-based birth defects surveillance system in Kampala, Uganda. ART regimens were recorded from hospital records and maternal self-reports. Using a log-binomial regression model, we compared the prevalence of 16 major external birth defects and other adverse birth outcomes among WLHIV on ART and HIV-negative women. A total of 203,092 births were included from 196,373 women of which 15,020 (7.6%) were WLHIV on ART. During pregnancy, 15,566 infants were primarily exposed to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART (n=13,614; 87.5%). After adjusting for maternal age, parity, and number of antenatal care (ANC) visits, WLHIV on NNRTI were more likely than HIV-negative women to deliver preterm (adjusted prevalence ratio [aPR]=1.27, 95% confidence interval [CI]: 1.21,1.32), post-term (aPR=1.23, 95% CI: 1.16,1.32), or small for gestational age infants (aPR=1.35, 95% CI: 1.30,1.40). Spina bifida was more prevalent among infants born to WLHIV on ART periconceptionally compared to HIV-negative women (aPR=2.45, 95% CI 1.27,4.33). The prevalence of the other selected birth defects were similar between infants from WLHIV on ART and HIV-negative women. In Uganda, WLHIV on ART were more likely than HIV-negative women to experience selected adverse birth outcomes. Further surveillance of maternal ART exposure, including by drug class and ART regimen, is needed to monitor and prevent adverse birth outcomes in WLHIV.

Multi-level determinants of timely routine childhood vaccinations in The Gambia: Findings from a nationwide analysis.

Achieving the ambitious goals of the Immunisation Agenda 2030 (IA2030) requires a deeper understanding of factors influencing under-vaccination, including timely vaccination. This study investigates the demand- and supply-side determinants influencing the timely uptake of key childhood vaccines scheduled throughout the first year of life in The Gambia. We used two nationally-representative datasets: the 2019-20 Gambian Demographic and Health Survey and the 2019 national immunisation facility mapping. Using Bayesian multi-level binary logistic regression models, we identified key factors significantly associated with timely vaccination for five key vaccines: birth dose of hepatitis-B (HepB0), first, second, and third doses of the pentavalent vaccine (Penta1, Penta2, Penta3), and first-dose of measles-containing vaccine (MCV1) in children aged 12-35months. We report the adjusted Odds Ratios (aORs) and 95% Credible Intervals (95% CIs) in each case. We found that demand-side factors, such as ethnicity, household wealth status, maternal education, maternal parity, and the duration of the household's residency in its current location, were the most common drivers of timely childhood vaccination. However, supply-side factors such as travel time to the nearest immunisation clinic, availability of cold-storage and staffing numbers in the nearest immunisation clinic were also significant determinants. Furthermore, the determinants varied across specific vaccines and the timing of doses. For example, delivery in a health facility (aOR=1.58, 95%CI: 1.02-2.53), living less than 30min (aOR=2.11, 95%CI: 1.2-8.84) and living between 30 and 60min (aOR=3.68, 95%CI: 1.1-14.99) from a fixed-immunisation clinic was associated with timely HepB0, a time-sensitive vaccine that must be administered within 24h of birth. On the other hand, children who received Penta1 and Penta2 on time were three- to five-fold more likely to receive subsequent doses on time (Penta2 and Penta3, respectively). Finally, proximity to an immunisation facility with functional vaccine cold-storage was a significant supply-side determinant of timely MCV1 (aOR=1.4, 95%CI: 1.09-1.99). These findings provide valuable insights for programme managers and policymakers. By prioritising interventions and allocating scarce resources based on these identified determinants, they can maximize their impact and ensure children in The Gambia receive timely vaccinations throughout their first year of life, contributing to IA2030 goals.

Drivers of stunting and wasting across serial cross-sectional household surveys of children under 2 years of age in Pakistan: potential contribution of ecological factors.

The impact of direct and indirect drivers on linear growth and wasting in young children is of public health interest. While the contributions of poverty, maternal education, empowerment and birth weight to early childhood growth are well recognized, the contribution of environmental factors like heat, precipitation, agriculture outputs and food security in comparable datasets is less well established. To investigate the association of length-for-age z-score (LAZ) and weight-for-length z-score (WLZ) with various indicators among children under 2 years of age in Pakistan using representative household level nutrition surveys and ecological datasets. Using geo-tagged metadata from Pakistan's 2011 and 2018 National Nutrition Surveys (NNS), anthropometric data from 29,887 children (9,231 from 2011 and 20,656 from 2018) were analyzed. Dietary intake and food security data for 140 districts were linked to gridded data on temperature, precipitation and soil moisture, and district measures of agriculture production of edible crops. Multiple linear regressions assessed factors associated with length for age Z score (LAZ) and weight for length z scores (WLZ) in index children. LAZ was positively associated with improved socio-economic conditions (β=0.06), food security (β=0.10), birth size (β=0.26), maternal age (β=0.02), BMI (β=0.02), height (β=0.02) and dietary score (β=0.03). Negative associations with LAZ were found for increased temperature, precipitation, diarrhea, household crowding and parity. Similar patterns were observed with WLZ for higher surface temperatures and precipitation were associated with declines in linear growth, alongside increased diarrhea prevalence and higher maternal parity. Apart from recognized multifactorial drivers of stunting and wasting among children such as poverty, food insecurity and maternal undernutrition, our analysis suggest the potential independent association with climatic factors such as heat and excess precipitation over time. These findings underscore the need for further research and potential integration of climatic mitigation and adaptation with nutrition response strategies.

Correlation Of Maternal Characteristics (Age, Parity, BMI) With Success Of Labor Induction Oxytocin Drip

Background: : Labor induction with oxytocin drip is an alternative action that can be used to overcome complications in the labor process. The study aims to determine the correlation between maternal characteristics (age, parity, BMI) and the success of labor induction oxytocin drips in Aminah Hospital Blitar City. Methods: The research design was cohort retrospective—Independent data on maternal age, parity, and BMI. Dependent data is the success of oxytocin drip labor induction. Data was obtained through medical record status with 50 respondent samples. It was taken using proportional random sampling, Inclusion criteria for oxytocin drip labor induction starting in the latent phase, and collected using the data collection instrument sheet on July 12 - 30, 2023. The data analysis used the Chi-Square test. Results: Results of the study showed that there was a relationship between maternal age and labor induction success with oxytocin drip, with an Asymp Sig (0,000) &lt; α (0,05). There was no relationship between parity and labor induction success with oxytocin drip, with an Asymp Sig (0,157) &gt; α (0,05). There was a relationship between BMI and labor induction success with oxytocin drip, with an Asymp Sig (0,000) &lt; α (0,05). Conclusion: Maternal age and BMI affect the success of labor induction, so women should give birth in a safe age range, which is 20-35 years, and a BMI of 18,5-24,9 kg/m2 will reduce the risk of failure in the labor process, especially labor with oxytocin drip induction.

Length of stay and its associated factors in the neonatal intensive care unit of Gadarif Hospital, Eastern Sudan: a retrospective study

BackgroundAttention is increasingly paid to length of stay (LOS) in neonatal intensive care units (NICUs) across countries. Few published data on neonatal LOS exist in Africa, where there is a high burden of neonatal morbidity and mortality. Thus, this study investigated the factors associated with neonatal LOS in the NICU of Gadarif Hospital, Eastern Sudan.MethodsA hospital-based retrospective study was conducted at Gadarif Hospital in Eastern Sudan from May to December 2020. Sociodemographic, maternal, and neonatal data were obtained from the hospital records. Poisson regressions were used to determine the adjusted relative risk (aRR) values and 95.0% confidence intervals (CIs).ResultsThis study enrolled 333 neonates admitted to the NICU and discharged alive. The median (interquartile range [IQR]) of maternal age and parity was 27.0 (23.0‒30.0) years and 3 (2‒5), respectively. Of the 333 neonates, 160 (48.0%) were males; 136 (40.8%) were delivered via cesarean section; 258 (77.5%) had low Apgar scores, and 74 (22.2%) had birth asphyxia. There were 140 (42.0%) low birth weight (LBW) neonates and 133 (39.9%) preterm neonates. The LOS range was 1–29 days (mean = 5.1 days), and its median (IQR) was 4 (2‒7) days. The multivariate Poisson analysis showed that increasing maternal age (aRR = 1.02, 95% CI = 1.01‒1.05), LBW (aRR = 1.48, 95% CI = 1.16‒1.90), preterm delivery (aRR = 1.27, 95% CI = 1.01‒1.61), a low Apgar score (aRR = 1.32, 95% CI = 1.06‒1.42), and an increasing white blood cell (WBC) count (aRR = 1.001, 95% CI = 1.001‒1.002) were associated with LOS. Parity (aRR = 0.85, 95% CI = 0.80‒0.91) was inversely associated with LOS. However, neonatal jaundice and mode of delivery were associated with LOS only in the univariate analysis.ConclusionIncreasing maternal age, preterm newborn, LBW, and a low Apgar score prolonged the LOS in this region of Sudan. Healthcare providers could leverage these identified factors to predict extended neonatal LOS in Eastern Sudan, enabling proactive interventions to enhance neonatal outcomes.

Epidemiology of Macrosomia in Saudi Arabia: An Analysis of 12,045 Pregnancies from the Riyadh Mother and Baby Multicenter Cohort Study (RAHMA) Database.

To investigate the prevalence, risk factors, and complications associated with delivering macrosomic babies. Singleton term pregnancies (12,045) were studied. Macrosomia was categorized using the following two definitions: birthweight > 4 kg and birthweight ≥ 90th percentile (3.7 kg). Regression models were developed to identify significant risk factors for macrosomia such as maternal age, parity, pre-pregnancy body mass index, gestational weight gain, and hyperglycemia. Other models were constructed to identify the independent effect of macrosomia on outcomes such as shoulder dystocia, emergency cesarean section, stillbirth, and low APGAR scores. The 50th centile birth weight of Saudi term infants is 3.18 kg; the 90th and 95th centiles were 3.70 and 3.91 kg, respectively. The prevalence of macrosomia (>4 kg) was 3.4%. The likelihood of macrosomia was associated with maternal age >40 years for newborns >4 kg, OR = 1.88, 95% CI (1.02-3.48), and maternal age < 18 for newborns ≥90th centile, OR = 5.23, 95% CI, (1.05-26.06). Regardless of the classification of macrosomia, it was associated with gestational age ≥41 weeks, parity > 4, pre-pregnancy BMI > 30, and maternal hyperglycemia. Macrosomia, using either definition, was associated with increased risk of shoulder dystocia, OR = 11.45, 95% CI (4.12-31.82) and OR = 9.65, 95% CI (3.89-23.94), and emergency CS, OR = 2.03, 95% CI (1.36-3.08) and OR = 1.77, 95% CI (1.34-1.52), for birthweight > 4 kg and ≥90th centile, respectively. Furthermore, newborns whose weights >4 kg were at greater risk to be stillborn, OR = 4.24, 95% CI (1.18-15.20), and to have low APGAR scores at birth, OR = 3.69, 95% CI (1.25-10.98). The risk of macrosomia among Saudi women significantly increases with maternal age, parity, gestational age, hyperglycemia, and pre-pregnancy obesity. Regardless of the definition used, delivering a macrosomic baby was associated with risks of shoulder dystocia and emergency cesarean section. Newborns (>4 kg) were at greater risk of stillbirth and low APGAR scores.

THE IMPACT OF THE COVID-19 PANDEMIC ON THE DIAGNOSIS AND TREATMENT OF ECTOPIC PREGNANCY: A RETROSPECTIVE COMPARISON

Objective: To investigate the impact of the COVID-19 pandemic on the diagnosis and treatment processes of ectopic pregnancies (EP) at a tertiary hospital in Turkey. Methods: This retrospective study compared 221 cases of tubal EP diagnosed after March 15, 2020, with 217 cases diagnosed before this date. Patient demographics, clinical characteristics, and treatment modalities were analyzed. Statistical analyses, including independent t-tests, Chi-square tests, and multinomial logistic regression, were conducted to assess differences between the COVID and pre-COVID periods. Results: The study found no significant differences in maternal age, gravidity, parity, or gestational weeks between the COVID and pre-COVID periods. However, there was a notable increase in patients presenting with abdominal pain (52.5% vs. 37.8%) and intraperitoneal hemorrhage (26.7% vs. 7.4%) during the COVID period. Despite the higher frequency of abdominal pain, vaginal bleeding was less common during the pandemic. Treatment approaches also shifted, with a significant increase in medical management (41.2% vs. 29.0%) and a slight decrease in surgical interventions during the COVID period. Multinomial logistic regression revealed that parity, gestational week, presence of Douglas fluid, and the period of diagnosis (COVID vs. pre-COVID) were significant predictors of treatment modality. Conclusion: The COVID-19 pandemic influenced the clinical presentation and management of ectopic pregnancies in our hospital. While there were no significant differences in key demographic or laboratory parameters, the increased presence of abdominal fluid and a shift towards medical management during the pandemic period suggest changes in patient presentation and treatment preferences. This study underscores the importance of maintaining vigilant diagnostic and therapeutic approaches for EP, even during global health crises.

Associations between sociodemographic exposures, growth and development during infancy with development at the age of eight years among children: Analysis of a maternal education trial in rural Uganda.

Links between early life exposures and child development later in life are not sufficiently explored in low- and middle-income countries. We studied associations between sociodemographic variables, growth and development at six to eight months with developmental outcomes at eight years. We used data from a maternal education trial which included 511 mother-infant pairs at children's age of six to eight months (baseline). In this follow-up study, data from 361 mother-child pairs were available. Questionnaires were used to collect sociodemographic variables. Growth (anthropometry) was measured by study personnel and converted to z-scores according to the World Health Organization (WHO) growth reference. Child development (cognitive, motor and language) at baseline was assessed using Bayley Scales of Infant and Todler Development, third edition (BSID-III). Development at eight years was measured using two neuropsychological tools: Kaufman Assessment Battery for Children Second Edition (KABC-II) and Test of Variables of Attention (TOVA). Higher weight-for-age z-scores (adjusted odds ratio (aOR) = 0.74; 95% confidence interval (CI) = 0.53, 0.98; P = 0.04), better maternal education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03). and better household head education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03) at six to eight months of age were associated with lower odds of scoring below average on KABC-II categorical scores at eight years of age. Motor composite scores and maternal parity at six to eight months of age were positively associated with auditory and visual TOVA scores (all P-values <0.05) at eight years. Cognitive composite scores at six to eight months of age were positively associated with visual TOVA scores (P < 0.05). In contrast, weight-for-length z-scores and household head age were negatively associated with both auditory and visual TOVA scores (P < 0.05). Being a female child was associated with lower auditory and visual TOVA scores (P < 0.05). At six to eight months of age, growth and development, gender, maternal education and parity, and household head age and education were associated with child development at eight years. Interventions emphasising improved growth and development in infancy, as well as parental educational attainment, may improve long-term developmental outcomes.

INTRA UTERINE FETAL DEATH in ADVANCED MATERNAL AGE AND GRAND MULTIPARA: CASE REPORT

Background: IUFD remains a significant public health issue globally, particularly in developing countries where access to prenatal care is limited. This report explores the compounded risks associated with advanced maternal age and high parity in such settings. Case Details: The patient, with a history of 12 prior pregnancies, lacked any form of prenatal monitoring and sought medical attention only after the onset of severe complications. Diagnostic assessments at the hospital confirmed the absence of fetal life through ultrasound. The patient underwent an emergency cesarean section to manage the stillbirth, highlighting the severe healthcare disparities and the need for emergency obstetric care in remote regions. Conclusion: This case underscores the urgent need for enhanced prenatal care and healthcare infrastructure in rural areas to prevent adverse pregnancy outcomes. Strategies should focus on educational programs and accessible healthcare services to manage high-risk pregnancies effectively in underserved populations.

Exploring Infant Size and Body Composition at 18 Months: An Ambidirectional Peri-Urban South African Cohort Study.

The first 1000 days of life lay the foundations for subsequent growth. This ambidirectional study, including prenatal, perinatal and postnatal factors, aimed to identify exposure variables affecting body size and composition and corresponding Z-score outcomes at age 18 months in infants born to women at low risk of adverse pregnancy outcomes in a peri-urban area of South Africa. Prenatal factors (maternal age, HIV status, anthropometry, parity, food insecurity and umbilical artery resistance index Z-score (UmA-RIAZ) as a measure of placental function, with higher UmA-RIAZ indicating poorer placental function); perinatal factors (infant sex, gestational age and birth anthropometry) and postnatal factors (infant feeding) were included as exposure variables, with infant anthropometry and body composition at 18 months as outcomes. Simple linear regression analysis was used to investigate associations between exposure variables and infant outcomes, and variables with p < 0.10 were included in the subsequent multiple regression analyses. Multiple regression analysis showed that higher UmA-RIAZ predicted lower birthweight [-0.11 kg (95% CI: -0.17, -0.04 kg)], birthweight-for-age Z-score [-0.24 (95% CI: -0.39, -0.09)] and 18-month infant length [-0.9 cm (95% CI: -1.4, -0.4 cm)] and length-for-age Z-score [-0.28 (95% CI: -0.45, -0.11)]. Maternal HIV infection predicted reduced 18-month infant length-for-age Z-score [-0.46 (95% CI: -0.83, -0.09)]. Household food insecurity predicted reduced fat-free mass-for-age Z-score at 18 months [-0.27 (95% CI: -0.51, -0.03)]. Infant anthropometry and body composition outcomes, therefore, are greatly affected by pre- and postnatal nutrition-related factors, such as placental insufficiency in utero and household food insecurity, with long-term consequences including stunting, which impact the individual, future generations and society.

Effects of a sorbitol-containing additive fed to dairy cows for 30 days postpartum.

The objective of this study was to determine the effects of early postpartum supplementation of Rally®, a sorbitol-containing feed additive (RAL), on lactation performance and automatic milking system (AMS) metrics on a commercial dairy farm. Multiparous (MT) and primiparous (PP) Holstein cows were randomly assigned to either RAL supplementation (570 g/d RAL; RAL-MT, n = 75, RAL-PP, n = 34) or control (CTL-MT, n = 72; CTL-PP, n = 38). The RAL cows were supplemented from 1 to 30 d in milk via an automated feed dispenser in the AMS. Milk production and other metrics were recorded for 1 to 90 DIM. Outcomes were analyzed with a linear mixed effect model with repeated measures. Analyses were conducted separately for the 2 periods: supplementation (1-30 DIM) or post-supplementation (31-90 DIM). Multiparous cows fed RAL produced 3.52 ± 1.29 kg more ECM per day than CTL cows during the supplementation period. The number of refusal visits/d to the AMS (visits when was not time for cows to be milked) during the supplementation period was 0.66 fewer for multiparous cows fed RAL than CTL cows. Daily milk yield and ECM yield, and number of refusal visits/d were similar for primiparous cows fed RAL or CTL during the supplementation period. Multiparous cows fed RAL continued to produce 2.17 ± 1.11 kg more ECM per day than CTL cows during the post-supplementation period. Rumination time during the post- supplementation period was 12.5 min less for multiparous cows fed RAL than CTL cows. The number of refusal visits/d during the post-supplementation period was 0.59 fewer for multiparous cows fed RAL compared with CTL cows. Daily milk yield and ECM yield, rumination time, and number of refusal visits per day during the post-supplementation period were similar between primiparous cows fed RAL and CTL cows. The results from this study indicate that RAL supplementation during the first 30 DIM increased milk yields when fed to multiparous cows.

Dilapan-S versus Standard Methods for Cervical Ripening in Term Pregnancies: An Individual Patient Data Meta-Analysis.

Dilapan-S is a cervical ripening agent approved by the FDA that has been found to be just as effective as other agents and can be utilized for outpatient ripening. No large-scale studies have been conducted to compare cesarean delivery rates between Dilapan-S and other ripening methods. Our objective was to combine these trials to compare cesarean delivery rates for Dilapan-S with other cervical ripening methods, overall and in sub-groups. The time period for this study was from January 1994 to April 2023. Ovid MEDLINE, Embase via Ovid, Ovid Emcare, CINAHL Plus, ClinicalTrials.gov, euclinicaltrialsregister.eu, and Scopus were searched. The study was conducted according to the Preferred Reporting Item for Systematic Reviews guidelines and was registered with PROSPERO (CRD42023423573). This was a systematic review and meta-analysis of individual patient data (IPD) from randomized controlled trials comparing Dilapan-S to other mechanical or pharmacologic cervical ripening methods for labor induction in singleton gestations. The main outcome measure assessed was the cesarean delivery (CD) rate in comparing Dilapan-S to alternative methods. Secondary maternal outcomes included changes in Bishop score post-intervention, vaginal delivery without complications, postpartum hemorrhage, cervical ripening issues, uterine infection, and patient satisfaction. Secondary neonatal outcomes were Apgar score <7 at 5 minutes, arterial cord pH <7.1, meconium presence, NICU admission and length of stay, hypoxic-ischemic encephalopathy, intraventricular hemorrhage, infant infection, and infant death. This study exclusively included randomized controlled trials (RCTs) involving participants who underwent labor induction during the third trimester of a singleton pregnancy. At least one group within these trials received Dilapan-S for the purpose of cervical ripening. Trials were excluded if induction occurred prior to 37 weeks of gestation or if cervical ripening was deemed unnecessary. Two reviewers independently selected studies, assessed the risk of bias using the Cochrane Risk of Bias Tool for randomized controlled trials, and extracted the data. Pre-specified subgroup analysis was performed for parity, BMI, Bishop score, and gestational age. Pooled odds ratios (ORs) adjusted for maternal age and parity with 95% confidence intervals (CI) were calculated using frequentist and Bayesian approaches. Four randomized controlled trials were identified, with 1731 women included (1036 allocated to Dilapan-S; 695 to alternative cervical ripening methods). CD rates were 28% and 30% with Dilapan-S and other methods, respectively. There was no difference in maternal age and parity-adjusted CD rates between Dilapan-S and other methods (OR 1.03, 95% CI 0.8-1.3). Bayesian inference indicated a 95% probability of being non-inferior (5% margin) and a 4.5% probability of being inferior to other methods. Subgroup analysis demonstrated significant interaction with parity with a 99% probability of lowering cesarean rates among multiparous women treated with Dilapan-S (RR 0.61, 95% CrI 0.4-0.9) compared to a 6% probability of benefit among nulliparous women (RR 1.13, 95% CrI 0.97-1.33). Pain levels ≥ 4 were significantly lower in the Dilapan-S group (46% vs. 62%; OR 0.5, 95% CI 0.40-0.64). Complication rates during cervical ripening (uterine hypertonus, uterine tachysystole, non-reassuring fetal heart tracing, and others) were also lower in the Dilapan-S group (19% vs. 47%; OR 0.28, 95% CI 0.28-0.37). Higher patient satisfaction was reported with Dilapan-S. Dilapan-S was at least non-inferior and marginally superior in lowering cesarean rates compared to other pre-induction cervical ripening agents. Parity impacted efficacy, with multiparous women benefiting the most.

Congenital Heart Defects in Paediatric Patients with Congenital Urogenital Abnormalities: A Cross-sectional Study

Introduction: Congenital Heart Defects (CHD) are the most significant co-morbidity in children with congenital anomalies of the kidney and urinary tract, according to past research. The fundamental cause is a combination of certain genetic factors and environmental influences on foetal development. Aim: To investigate the incidence of CHD in congenital urogenital abnormalities in paediatric patients. Materials and Methods: A cross-sectional study was conducted at Dr. D.Y. Patil Medical College, Pune, Maharashtra, India, from June 2023 to December 2023 on 110 patients with congenital urogenital abnormalities undergoing elective surgical procedures to find the incidence of CHDs. All routine investigations, clinical history and examination, ultrasonography, and echocardiography were done. The association of the variables that were quantitative and not normally distributed in nature was analysed using the Mann-Whitney’s Test, and variables that were quantitative and normally distributed in nature were analysed using an independent t-test. The association of variables which were qualitative in nature was analysed using the Fischer’s-exact test. Results: The maternal demographic characteristics that were included were maternal age, gestational age, parity, and consanguinity of marriage. The mean maternal age was 25.65±2.79 years. The mean gestational age was 38.55±1.27 weeks. Consanguinity of marriage was observed in four out of 110 cases. Out of 110 cases, the mean primigravida was 37.27%, gravida 2 was 46.36%, gravida 3 was 13.4%, and gravida 4 was 2.73%. The demographic characteristics of children with urogenital anomalies showed a female-to-male ratio of 50:60. Clinically, a murmur was observed in 15% of cases, and other anomalies were detected in two cases. Out of the total 110 patients with urogenital abnormalities, 15 patients had CHD. Among the 15 cases, four cases were Atrial Septal Defects (ASD), six cases were Patent Ductus Arteriosus (PDA), and five cases were Ventricular Septal Defects (VSD). The total incidence of CHDs was 13.6%. Conclusion: Therefore, authors infered that the incidence of CHD was 13.6% in paediatric patients with congenital urogenital abnormalities. Children with congenital urogenital abnormalities need to be investigated with routine echocardiography. Thus, early diagnosis and therapeutic intervention of CHDs shall not only improve the surgical outcome of congenital urogenital anomalies but also improve the long-term outcome of this highrisk patient population.

The association between maternal age and parity with prolonged labor: A literature review

Introduction: Labor and childbirth are essential parts of the human life cycle. When labor extends longer than expected, it’s referred to as prolonged labor, a complication that contributes to over 810 maternal deaths each year worldwide and accounts for over 69,000 cases annually. In fact, prolonged labor is the most frequently reported childbirth complication, occurring in 41% of cases. Past research has shown that a mother's age and the number of children she has (parity) can influence the risk of prolonged labor. More research is needed to understand better how these factors impact prolonged labor. Method: This study is a literature review, drawing from sources in Google Scholar, PUBMED, and Science Direct, focusing on research published between 2019 and 2024. The study included only original research articles in English or Indonesian with all the required components. Result and Discussion: From the literature search, 10 studies met the inclusion criteria. Among these, 7 studies found a strong correlation between maternal age and prolonged labor, while 2 found no correlation. Furthermore, 9 studies indicated a significant relationship between parity and prolonged labor, while 1 study described the characteristics of mothers who experienced prolonged labor. Conclusion: In general, maternal age is related to the risk of prolonged labor, though a few studies showed no link. Parity is also significantly associated with prolonged labor.

Exploring maternal parity and the feasibility of childbirth in space: Insights from terrestrial and extraterrestrial research

This comprehensive study, led by Ghaffari, explores the relationship between parity and various maternal health outcomes by analyzing 260 maternal death cases across Iran over a three-year period. The research, pioneering in its focus on astronaut-mothers, examines the association of parity with factors such as prolonged labor, rapid labor, induction rates, retained placenta, placental curettage, peripartum cardiomyopathy, vaginal bleeding, postnatal wellness, and maternal mortality. Methodologically, the study conducts a thorough statistical analysis of these parameters, aiming to identify patterns that may inform astronaut selection criteria for future space missions involving childbirth. Despite finding no significant correlation between parity and maternal health outcomes, the study underscores the need for further research on parity-specific differences, as current literature often amalgamates data for multiparous women. This research provides pivotal insights for advancing maternal health considerations in the unique context of space exploration.