Low Birth Weight Delivery Research Articles

A cluster randomized trial of xylitol chewing gum for prevention of preterm birth: The PPaX trial.

Maternal periodontal disease is associated with preterm and low-birthweight deliveries, but randomized trials of likely efficacious treatments (e.g., dental scaling and root planing) during pregnancy have not reduced these adverse outcomes. As an alternative, we hypothesized that periconception initiation of xylitol chewing gum would reduce the occurrence of preterm or low-birthweight deliveries among a historical high-prevalence population in Malawi. We conducted an open-label, parallel-enrollment, matched-pair, cluster-randomized, controlled clinical trial across eight health centers (sites) in and around Lilongwe, Malawi. Sites were paired by anticipated delivery volume and randomized to prenatal and oral health education alone (active control) or with twice-daily xylitol chewing gum (intervention) throughout the periconception and antenatal periods. Forthe primary prevention of preterm (<37weeks) and low-birthweight (<2,500 g) deliveries (co-primary outcomes), comparison by allocation group was performed using generalized linear mixed models for each outcome as a fixed factor and the site(s) as a random factor. 10,069 participants were enrolled (n= 4,549 at intervention sites, n= 5,520 at active control sites), with >95% available for analyses. Initiation of xylitol chewing gum resulted in significant reductions in the co-primary outcomes: preterm birth (12.6% [549/4,349] vs. 16.5% [878/5,321]; relative risk [RR] 0.76, 95% confidence interval [CI] 0.57-0.99) and <2,500-g neonates (8.9% [385/4,305] vs. 12.9% [679/5,260]; RR 0.70, 95% CI 0.49-0.99). Xylitol chewing gum use also led to fewer neonatal demises (0.2% [8/4,305] vs. 0.4% [22/5,260]; RR 0.41, 95% CI 0.19-0.89). Periconception initiation and ongoing use of xylitol chewing gum significantly reduced the occurrence of preterm and low-birthweight deliveries in Malawi. E.W. Al Thrasher Foundation (to K.A.) and USAID Saving Lives at Birth Grand Challenges Grant AID-OAA-G-11-00062 (to K.A.). Additional financial and in-kind support was graciously provided by Texas Children's Hospital and Baylor Foundation Malawi.

Study of placenta histopathology in low birth weight deliveries: A prospective cross-sectional study at Nobel Medical College Teaching Hospital

Background: Placenta is the most important organ that represents the status of the mother and fetus. Its examination on gross and microscopy can reveal varied pregnancy-related diseases, decreasing future adverse pregnancy outcomes. This study aims to examine the placenta histopathologically among low birth weight pregnancies. Materials and methods: A prospective case-control study was conducted in the Department of Pathology over one year. The placenta of low birth weight (weight &lt; 2.5 kg) term pregnancies were histopathologically examined. The maternal demographics, co-morbidity, gravida, and hemoglobin levels were recorded. Descriptive statistics, and student t-test or Chi-square test were used for two-group analysis. Results: Thirty-two consecutive patients enrolled in each group. A significant proportion of the patients in the study group were anemic (9.2 vs. 11.5 gm/dl; p=0.03). Pregnancy-induced hypertension rate was significantly higher in the study group (31% vs. 9%; p = 0.042). Gross observations in low birth weight pregnancies were sub-chorionic fibrin deposition (75%), calcification (37%) and infarction (31%). On microscopy, chorionic vessel thrombosis was significantly higher in the study group (56% vs. 6%; p= 0.003). Furthermore, chorioamnionitis (34%) and placental floor infarction (12%) were also observed in a significantly higher number of placentas in the study group. Conclusions: Anemia and pregnancy-induced hypertension are important associated factors for low birth weight pregnancies. Pathological examinations reveal higher fibrin deposition, infarction, calcification, sub-chronic vessel thrombosis, and chorioamnionitis in low birth weight placenta.

Predictors of effective kangaroo mother care, exclusive breastfeeding, and skin-to-skin contact among low birthweight newborns in Amhara, Ethiopia.

Globally, 20% of all newborns are born with low birth weight (LBW). There is, therefore, an urgent need to expedite the delivery of high-impact, evidenced-based, and low-cost interventions such as kangaroo mother care (KMC (defined as continuous skin-to-skin care) and exclusive breastfeeding for this vulnerable group. A multinational World Health Organization (WHO)-supported consortium created and tested the impact of locally-specific and globally-informed phases of KMC care on KMC uptake/scale-up across multiple sites. Here we report on the study of KMC predictors that is nested within Amhara's KMC implementation trial in Amhara, Ethiopia. We used multivariate logistic regression phases to identify diverse predictors of KMC, skin-to-skin contact, and exclusive breastfeeding at hospital discharge and day 28 of life. We analysed data from 860 LBW newborns. At day 28, implementation period (adjusted odds ratio (aOR) = 3.2-5.0), hospital facility (aOR = 3.0-4.6), and having multiple births (aOR = 0.31) were the strongest predictors of effective KMC. Meanwhile, previous death of a newborn, type of health facility where delivery occurred, and previous LBW delivery were predictors of effective KMC at both time points. No single factor predicted KMC, skin-to-skin contact, and exclusive breastfeeding at all time points and across all implementation periods. Having multiple births was a negative predictor for skin-to-skin contact, while the implementation period and having older fathers (>29 years) were strong positive predictors for exclusive breastfeeding at both discharge and day 28. Mothers with a previous history of neonatal death and current skin-to-skin-care uptake strongly predicted exclusive breastfeeding uptake at both time points. At discharge, however, having a history of preterm birth and neonatal death strongly predicted exclusive breastfeeding uptake, while multiple current births, current very LBW newborns, and the use of standard binders decreased the likelihood of exclusive breastfeeding. To achieve the effective KMC coverage target of ≥80% in Ethiopia, KMC scale-up phases may have to consider the key predictors of KMC, EBF, and SSC to effectively target beneficiaries.

Comparative Safety of In Utero Exposure to Buprenorphine Combined With Naloxone vs Buprenorphine Alone

Buprenorphine combined with naloxone is commonly used to treat opioid use disorders outside of pregnancy. In pregnancy, buprenorphine alone is generally recommended because of limited perinatal safety data on the combination product. To compare perinatal outcomes following prenatal exposure to buprenorphine with naloxone vs buprenorphine alone. Population-based cohort study using health care utilization data from Medicaid-insured beneficiaries in the US from 2000 to 2018. The cohort was restricted to pregnant individuals linked to their liveborn infants, with maternal Medicaid enrollment from 3 months before pregnancy to 1 month after delivery and infant enrollment for the first 3 months after birth, unless they died sooner. Use of buprenorphine with naloxone vs buprenorphine alone during the first trimester based on outpatient dispensings. Outcomes included major congenital malformations, low birth weight, neonatal abstinence syndrome, neonatal intensive care unit admission, preterm birth, respiratory symptoms, small for gestational age, cesarean delivery, and maternal morbidity. Confounder-adjusted risk ratios were calculated using propensity score overlap weights. This study identified 3369 pregnant individuals exposed to buprenorphine with naloxone during the first trimester (mean [SD] age, 28.8 [4.6] years) and 5326 exposed to buprenorphine alone or who switched from the combination to buprenorphine alone by the end of the first trimester (mean [SD] age, 28.3 [4.5] years). When comparing buprenorphine combined with naloxone with buprenorphine alone, a lower risk for neonatal abstinence syndrome (absolute risk, 37.4% vs 55.8%; weighted relative risk, 0.77 [95% CI, 0.70-0.84]) and a modestly lower risk for neonatal intensive care unit admission (absolute risk, 30.6% vs 34.9%; weighted relative risk, 0.91 [95% CI, 0.85-0.98]) and small for gestational age (absolute risk, 10.0% vs 12.4%; weighted relative risk, 0.86 [95% CI, 0.75-0.98]) was observed. For maternal morbidity, the comparative rates were 2.6% vs 2.9%, respectively, and the weighted relative risk was 0.90 (95% CI, 0.68-1.19). No differences were observed with respect to major congenital malformations overall, low birth weight, preterm birth, respiratory symptoms, or cesarean delivery. Results were consistent across sensitivity analyses. There were similar and, in some instances, more favorable neonatal and maternal outcomes for pregnancies exposed to buprenorphine combined with naloxone compared with buprenorphine alone. For the outcomes assessed, compared with buprenorphine alone, buprenorphine with naloxone during pregnancy appears to be a safe treatment option. This supports the view that both formulations are reasonable options for the treatment of opioid use disorder in pregnancy, affirming flexibility in collaborative treatment decision-making.

Obstetric Characteristics and Outcomes of Gestational Carrier Pregnancies

Advancements in assisted reproductive technology (ART) have led to an increase in gestational carrier (GC) pregnancies. However, the perinatal outcomes of GC pregnancies remain understudied, necessitating a deeper understanding of their associated risks. To assess maternal characteristics and obstetric outcomes associated with GC pregnancies. A comprehensive systematic search of publications published before October 31, 2023, using PubMed, Web of Science, Scopus, and Cochrane Library databases was conducted. Two authors selected studies examining obstetric characteristics and outcomes in GC pregnancies with 24 or more weeks' gestation. Studies with insufficient outcome information, unavailable data on gestational surrogacies, and non-English language studies were excluded. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 2 investigators extracted and synthesized both quantitative and qualitative data. Both fixed-effect and random-effect analysis were used to pool data. The primary outcomes were obstetric characteristics and outcomes, including hypertensive disorders, preterm birth, and low birth weight. Secondary outcomes included severe maternal morbidity and mortality associated with GC pregnancies. Six studies from 2011 to 2023 involving 28 300 GC pregnancies and 1 270 662 non-GC pregnancies were included. GCs accounted for 2.5% of in vitro fertilization cycles (59 502 of 2 374 154 cycles) and 3.8% of ART pregnancies (26 759 of 701 047 ART pregnancies). GC pregnancies were more likely to be conceived by frozen embryo transfer compared with non-GC ART pregnancies (odds ratio [OR], 2.84; 95% CI, 1.56-5.15), and rates of single embryo transfer were similar between the 2 groups (OR, 1.18; 95% CI, 0.94-1.48). GCs were rarely nulliparous (6 of 361 patients [1.7%]) and were more likely to have multifetal pregnancies compared with non-GC ART patients (OR, 1.18; 95% CI, 1.02-1.35). Comparator studies revealed lower odds of cesarean delivery (adjusted OR [aOR], 0.42; 95% CI, 0.27-0.65) and comparable rates of hypertensive disorders (aOR, 0.86; 95% CI, 0.45-1.64), preterm birth (aOR, 0.82; 95% CI, 0.68-1.00), and low birth weight (aOR, 0.79; 95% CI, 0.50-1.26) in GC pregnancies vs non-GC ART pregnancies. Comparatively, GC pregnancies had higher odds of hypertensive disorders (aOR, 1.44; 95% CI, 1.13-1.84) vs general (non-GC ART and non-ART) pregnancies with comparable cesarean delivery risk (aOR, 1.06; 95% CI, 0.90-1.25). Preterm birth and low birth weight data lacked a comparative group using multivariate analysis. Severe maternal morbidity and maternal mortality were rare among GCs. In this systematic review and meta-analysis, although GC pregnancies had slightly improved outcomes compared with non-GC ART pregnancies, they posed higher risks than general pregnancies. Contributing factors may include ART procedures and increased rates of multiple gestations which influence adverse perinatal outcomes in GC pregnancies.

Lifetime History of Low Birth Weight Delivery and Cognitive Function in Middle-Aged Parous Women.

Pregnancy outcomes such as low birth weight (LBW) delivery may reflect vascular or metabolic dysfunction in mothers and presage future cognitive impairment and dementia. However, the evidence is currently limited. Our objective was to examine the extent to which a lifetime history of LBW delivery was associated with cognitive function in parous middle-aged women. We studied participants from the Nurses' Health Study II, an ongoing longitudinal cohort of female nurses enrolled in 1989. In 2009, participants completed a reproductive history questionnaire. Participants who completed at least one of 2 post-traumatic stress disorder questionnaires were invited to participate in a cognition substudy with 2 waves of baseline data collection (2014 or 2018). We restricted the analysis to participants with one valid cognitive assessment who reported ≥1 birth at 18 years and older. We defined LBW delivery history as having delivered offspring with a birth weight <2,500 g (<5.5 lbs) in any pregnancy. The outcome was a single assessment of cognitive function evaluated with the self-administered Cogstate Brief Battery. The battery comprises 4 tasks, which we used to create 2 composite z-scores measuring psychomotor speed/attention and learning/working memory (higher z-scores = better cognitive function). We used multivariable linear regression models. The analysis included 15,323 participants with a mean age of 62 (standard deviation: 4.9 years) at cognitive assessment. Among them, 1,224 (8%) had a history of LBW delivery. After adjusting for age at cognitive assessment, race, and ethnicity, participants' education, wave of baseline cognitive assessment, socioeconomic status, and prepregnancy characteristics, women with a history of LBW delivery had lower z-scores in the psychomotor speed/attention (β, -0.06; 95% CI -0.12 to -0.01) and learning/working memory (β, -0.05; 95% CI -0.09 to -0.01) composites than parous women without a history of LBW delivery. We observed a gradient of lower z-scores with an increasing number of LBW deliveries. History of LBW delivery may be marker of future poorer cognition. If confirmed, our findings support future investigations into the value of early preventive efforts targeting women with a history of LBW delivery to reduce the burden of cognitive impairment in women.

Analysis of Pregnancy Outcomes in Women with Polycystic Ovary Syndrome (PCOS): A Retrospective Study

ABSTRACT Introduction: Although PCOS affects reproductive health, its consequences on the outcome of pregnancies are still up for discussion. Comparing the pregnancy outcomes of women with PCOS to a control group was the goal of this retrospective research. Methods: Analysis of data from tertiary care centers between 2017 and 2022 was done in retrospective. While the controls (n = 300) matched for age, BMI, and parity, the PCOS group (n = 300) satisfied Rotterdam criteria. Maternal-fetal health, birth outcomes, and gestational problems were evaluated. Results: Compared to controls, women with PCOS had a greater incidence of preeclampsia (12.3% vs. 8.1%, P = 0.023) and gestational diabetes (18.7% vs. 9.8%, P &lt; 0.001). On the other hand, there were no notable variations in low birth weight (P = 0.589) or preterm delivery (P = 0.321). Conclusion: In summary, the correlation between PCOS and increased risks of gestational diabetes and preeclampsia emphasizes the necessity of customized therapies. The intricacy of PCOS’s influence on birth outcomes is shown by the inconclusive results regarding preterm delivery and low birth weight, which call for more research to enhance mother and newborn health in this group.

Soil-transmitted Helminth Infection and Perinatal Outcomes in Pregnant Women in Primary Care Settings in South India: A Cohort Study.

Soil-transmitted helminth infections (STHs) in pregnancy have been linked to maternal anemia, low birth weight, and adverse perinatal outcomes. STH includes Ascaris lumbricoides, hookworm, and Trichuris trichiura. However, conflicting evidence exists regarding these effects. Hence, we aimed to assess the association of STH infections with perinatal outcomes. A community-based cohort study was conducted among pregnant women in primary care settings in Puducherry, South India, during December 2019 to April 2021. Stool samples were collected for STH screening and confirmed using polymerase chain reaction. Information on perinatal outcomes and hemoglobin levels were extracted from case records. The association of pre-term birth, low birth weight, anemia, and miscarriages with STH infection was analyzed using the Chi-square test. Among the 650 women enrolled, 58 (8.9%) had one of the STH infections. At the time of recruitment, 336 (52.0%) women had anemia. Twenty-four women (3.7%) had miscarriages, 14 (2.2%) had pre-term birth, and 65 (10.4%) had low-birth-weight (LBW) babies. All 14 pre-term babies had LBW, and out of 65 LBW, 40 were in mothers with anemia. Incidence of LBW, pre-term deliveries, and anemia were higher in women with STH than in those without STH (LBW: 12.3% vs 10.2%, P = 0.62; pre-term: 3.5% vs 2.1%, P = 0.5; and anemia: 54.4% vs 51.85, P = 0.7). Though the incidence of anemia, LBW, and pre-term delivery was higher in women with STH infections compared to those without STH, we did not find any significant association between the presence of STH infections and perinatal outcomes.

Assessment of Neonatal Mortality amongst Sick Neonates in the Special Care Baby Unit of a Tertiary Institution in Orlu, Nigeria

Introduction: Neonatal mortality constitutes more than 41% of under 5 mortality in sub-Saharan Africa, despite advancement in technology and concerted effort aimed at decreasing under-five mortality. This study aims at assessing the risk factors and causes of neonatal mortality among sick infants in the special care baby unit (SCBU); focused at identification of possible areas of improvement in care and result. Methods: A retrospective review of medical records of sick neonates admitted into SCBU of Imo State University Teaching Hospital Orlu. Sociodemographic and clinical characteristics of 214 sick neonates that died was obtained out of the 948 admitted/treated over a five year period (2018-2022). Descriptive statistics was used to summarize data, logistic regression at 95% level of significance was used to determine association between independent variables and neonatal death. Values of p &lt; 0.05 were considered significant. Results: A total of 948 sick neonates were admitted into SCBU, with a neonatal mortality rate of 22.6%. Complications of prematurity 78 (36.7%), severe birth asphyxia 63(29.6%) and neonatal sepsis 31(14.6%) are the leading causes of death with majority of death occurring in the first 24 hours of life 130(60.8%). Low birth weight [OR=2.59 (95% CI 1.84-3.54)], prematurity [OR=2.79 (95% CI 2.03-3.83)] and spontaneous vaginal deliveries [OR=1.85 (95% CI 1.32-2.60)] were positively associated with increased mortality. While Caesarean section as mode of delivery [OR=0.54 (95% CI 0.38-0.76)] and birth weight &gt;2.5-4.0kg [OR=0.46 (95% CI 0.34-0.64)] significantly reduced neonatal mortality. Conclusion: Neonatal mortality rate is still unacceptably high, with complications of prematurity, severe birth asphyxia and neonatal sepsis contributing the highest percentage of poor outcome (death). Low birth weight, prematurity, and spontaneous vaginal deliveries were positively associated with increased mortality. Multidisciplinary measures aimed at reduction of neonatal morbidity and mortality such as improving the utilization of antenatal care services, quality of care at delivery, at the neonatal intensive care unit needs be strengthened.

Pattern of Disease Admissions and Their Outcome of Neonates Admitted In Neonatal Intensive Care Unit of A Tertiary Care Hospital in Quetta

Objective: to determine the admission pattern and outcomes of neonatal admissions to a neonatal intensive care unit (NICU) in a tertiary care hospital of Quetta Pakistan. Study Design: Prospective longitudinal study. Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital (CMH), Quetta Pakistan, from Jan to Dec 2020. Methodology: All neonates admitted to the NICU Indoor or Outdoor Department during study duration were included. The disease pattern of the admission was noted, along with information regarding gender, gestational age, birth weight, diagnosis, duration of NICU stay, and outcome. Results: Of 424 neonates, respiratory-related disorders were predominantly higher (185,43.6%) followed by infection/sepsis-related disorders (105,24.8%), care of prematurity (81,19.1%), whereas 53(12.5%) had miscellaneous disorders. The overall mortality rate was observed in 34(8.0%) babies. A significant mean difference in gestational age (p: &lt;0.001), birth weight (p: &lt;0.001), and duration of stay (p: 0.003) was observed for reasons for admissions. Furthermore, a significant association of reasons for admission was observed with gender (p: 0.013), route of admission (p: &lt;0.001), and respiratory support (p: &lt;0.001). Conclusion: The pattern of the disease admission showed that respiratory-related disorders were predominantly higher, followed by infection/sepsis-related disorders and care of prematurity. Though the mortality rate was low, however, low birth weight, prematurity, and caesarean delivery are common risk factors.

Sustained clinical benefit of malaria chemoprevention with sulfadoxine-pyrimethamine (SP) in pregnant women in a region with high SP resistance markers

The effectiveness of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is threatened by increasing SP-resistance in Africa. We assessed the level of SP-resistance markers, and the clinical and parasitological effectiveness of IPTp-SP in southern Mozambique. P. falciparum infection, antimalarial antibodies and dhfr/dhps SP-resistance mutants were detected by quantitative polymerase chain reaction (qPCR), suspension array technology and targeted deep sequencing, respectively, among 4016 HIV-negative women in Maputo province (2016-2019). Univariate and multivariate regression models were used to assess the association between taking the recommended three or more IPTp-SP doses (IPTp3+) and parasitological and clinical outcomes. 84.3% (3385/4016) women received three or more IPTp-SP doses. The prevalence of quintuple mutants at first antenatal care (ANC) visit was 94.2%. IPTp3+ was associated with a higher clearance rate of qPCR-detected infections from first ANC visit to delivery (adjusted odds ratio [aOR]=5.9, 95% CI: 1.5-33.3; p=0.012), lower seroprevalence at delivery of antibodies against the pregnancy-specific antigen VAR2CSADBL34 (aOR=0.72, 95% CI: 0.54-0.95; p=0.022), and lower prevalence of low birth weight deliveries (aOR: 0.61, 95% CI: 0.41-0.90; p=0.013). A sustained parasitological effect of IPTp-SP contributes to the clinical effectiveness of IPTp3+ in areas with high prevalence of SP-resistance markers.

The difference in early trimester fetal growth between singletons after frozen embryo transfer and fresh embryo transfer

Frozen embryo transfer resulted in a higher birthweight and an increased risk of macrosomia than fresh embryo transfer. However, the mechanism was still unclear. When the impact of frozen embryo transfer on fetal growth began was unknown. Crown-rump length at 11-13 weeks had been regarded as a good indicator of fetal growth in the first trimester and had been used for gestational age calculation in women with uncertain last menstrual periods. To evaluate the association between frozen embryo transfer and early fetal growth, particularly the crown-rump length, then fresh embryo transfer. The secondary objective was to investigate the potential correlation between crown-rump length and birthweight. This was a retrospective cohort study conducted at the Reproductive Medical Center of Shandong University. A total of 4949 patients who obtained singleton pregnancy after frozen embryo transfer and 1793 patients who got singleton pregnancy after fresh embryo transfer between January 1, 2017 and December 31, 2022 were included. The primary outcome was the crown-rump length measured via ultrasound at 11-13 weeks gestation. The secondary outcomes were perinatal outcomes, including birthweight and the risk of large for gestational age, small for gestational age, macrosomia, low birthweight, and premature delivery. Multivariable linear regression models were used to adjust for potential confounders of crown-rump length. A total of 6742 live singleton births after frozen embryo transfer or fresh embryo transfer were included in this study. In the univariable analysis, the frozen embryo transfer group had a larger crown-rump length (5.75±0.53 cm vs 5.57±0.48 cm, P<.001) and an increased risk of larger-than-expected crown-rump length (13.5% vs11.2%, P=.013) than the fresh embryo transfer group. After adjusting for confounders in multivariable linear regression models, frozen embryo transfer was still associated with a larger crown-rump length (regression coefficient, 3.809 [95% confidence intervals, 3.621-3.997], P<.001). When subgrouped by fetal gender, the crown-rump length of the frozen embryo transfer group was larger than the fresh embryo transfer group in both male and female fetuses. In addition, the crown-rump length was consistently larger in the frozen embryo transfer group than the fresh embryo transfer group in subgroups of the peak estradiol levels. The comparisons among different crown-rump length groups showed that smaller-than-expected crown-rump length was associated with increased risks of small for gestational age (6.3% vs 3.0%, P<.001) and preterm delivery (9.6% vs 6.7%, P=.004) than normal crown-rump length. Frozen embryo transfer was associated with a larger crown-rump length than fresh embryo transfer, suggesting that the effect of frozen embryo transfer on fetal growth may begin in the early trimester. Suboptimal fetal growth in the first trimester may be associated with low birthweight and premature delivery.

Risk factors associated with neonatal mortality among neonates admitted to neonatal intensive care unit of the University Teaching Hospital in Lusaka

Globally, several children die shortly after birth and many more of them within the first 28 days of life. Sub-Sharan Africa accounts for almost half (43%) of the global neonatal death with slow progress in reduction. These neonatal deaths are associated with lack of quality care at or immediately after birth and in the first 28 days of life. This study aimed to determine the trends and risk factors of facility-based neonatal mortality in a major referral hospital in Lusaka, Zambia. We conducted retrospective analysis involving all neonates admitted in the University Teaching Hospital Neonatal Intensive Care Unit (UTH-NICU) in Lusaka from January 2018 to December 2019 (N = 2340). We determined the trends and assessed the factors associated with facility-based neonatal mortality using Generalized Linear Models (GLM) with a Poisson distribution and log link function. Overall, the facility-based neonatal mortality was 40.2% (95% CI 38.0–42.0) per 1000 live births for the 2-year period with a slight decline in mortality rate from 42.9% (95% CI 40.0–46.0) in 2018 to 37.3% (95% CI 35.0–40.0) in 2019. In a final multivariable model, home delivery (ARR: 1.70, 95% CI 1.46–1.96), preterm birth (ARR: 1.59, 95% CI 1.36–1.85), congenital anomalies (ARR: 1.59, 95% CI 1.34–1.88), low birthweight (ARR: 1.57, 95% CI 1.37–1.79), and health centre delivery (ARR: 1.48, 95% CI 1.25–1.75) were independently associated with increase in facility-based neonatal mortality. Conversely, hypothermia (ARR: 0.36, 95% CI 0.22–0.60), antenatal attendance (ARR: 0.76, 95% CI 0.68–0.85), and 1-day increase in neonatal age (ARR: 0.96, 95% CI 0.95–0.97) were independently associated with reduction in facility-based neonatal mortality. In this hospital-based study, neonatal mortality was high compared to the national and global targets. The improvement in neonatal survival observed in this study may be due to interventions including Kangaroo mother care already being implemented. Early identification and interventions to reduce the impact of risks factors of neonatal mortality in Zambia are important.

Cost-effectiveness of universal routine sonographic cervical-length measurement at 19 to 25 weeks’ gestation

National second-trimester scanning of cervical length was introduced in Israel in 2010, and in the decade thereafter, a significant systematic reduction in preterm birth and in the delivery of low birthweight babies was found among singletons. In this study, we sought to estimate the cost-effectiveness of a national policy mandating second-trimester cervical length screening by ultrasound, followed by vaginal progesterone treatment for short cervical length in comparison with no screening strategy. We constructed a decision model comparing 2 strategies, namely (1) universal cervical length screening, and (2) no screening strategy. This study used the national delivery registry of Israel's Ministry of Health. All women diagnosed with a second-trimester cervical length <25 mm were treated with vaginal progesterone and were monitored with a bimonthly ultrasound scan for cervical dynamics and threat of early delivery. Preterm birth prevalence associated with short cervical length, the efficacy of progesterone in preterm birth prevention, and the accuracy of cervical length measurements were derived from previous studies. The cost of progesterone and bimonthly sonographic surveillance, low birthweight delivery, newborn admission to intensive care units, the first-year costs of managing preterm birth and low birthweight, and instances of handicaps and the cost of their follow-up were extracted from the publicly posted registry of Israel's Ministry of Health and Israel Social Securities data. Monte Carlo simulations decision tree mode, Tornado diagrams, and 1- and 2-way sensitivity analyses were implemented and the base case and sensitivity to parameters that were predicted to influence cost-effectiveness were calculated. Without cervical length screening, the discounted quality-adjusted life years were 30.179, and with universal cervical length screening, it increased to 30.198 (difference of 0.018 quality-adjusted life years). The average cost of no screening for cervical length strategy was $1047, and for universal cervical length screening, it was reduced to $998. The calculated incremental cost-effectiveness ratio was -$2676 per quality-adjusted life year (dividing the difference in costs by the difference in quality-adjusted life years). Monte Carlo simulation of cervical length screening of 170,000 singleton newborns (rounded large number close to the number of singleton newborns in Israel) showed that 95.17% of all babies were delivered at gestational week ≥37 in comparison with 94.46% of babies with the no screening strategy. Given 170,000 singleton births, the national savings of screening for short cervical length when compared with no cervical length screening amounted to $8.31M annually, equating to $48.84 for a base case, and the incremental cost-effectiveness ratio for each case of low birthweight or very low birthweight avoided was -$14,718. A cervical length <25 mm was measured for 30,090 women, and of those, 24,650 were false positives. The major parameters that affected the incremental cost-effectiveness ratio were the incidence of preterm birth, the specificity of cervical length measurements, and the efficacy of progesterone treatment. At a preterm birth incidence of <3%, universal screening does not lead to a cost saving. National universal cervical length screening should be incorporated into the routine anomaly scan in the second trimester, because it leads to a drop in the incidence of preterm birth and low birthweight babies in singleton pregnancies, thereby saving costs related to the newborn and gaining quality-adjusted life years.

The Beneficial Impact of Iron-Fortified Complementary Feeding in the Burden of Iron Deficiency Anaemia (IDA) in Children of Bangladesh

Fortifying food with iron is the most cost-effective way to avoid iron deficiency anemia, a global public health crisis. In addition to choosing the appropriate dietary context for ingestion, it is critical to choose the appropriate iron form and food carrier. Among the increased hazards include low birth weight and preterm delivery. Children with IDA have slower development, worse cognitive performance, and lower levels of physical activity. In women, it also raises the risk of morbidity and death. The amount of iron required in the diet, one&amp;apos;s socioeconomic status, and overall health are all crucial factors to take into account. To combat IDA, a variety of dietary approaches, iron-fortified foods, supplements, and disease management techniques have all been employed. Nowadays, food fortification with iron is seen to be a long-term, sustainable solution. To be effective, the iron fortification program&amp;apos;s food transporters and fortificants must be deemed safe, pleasant, and acceptable by the target population. It also shouldn&amp;apos;t have a detrimental effect on the stability and acceptance of the finished product. This article provides a thorough summary of the current state of iron deficiency in women and children in Bangladesh. This study addresses current issues as well as the efficacy of current therapeutic strategies. Prevention-focused treatments ought to take precedence over treatment-focused ones in high-risk populations. Unknown are the long-term benefits, and unfavorable outcomes are possible. Despite the tremendous progress made, several plans and initiatives are still being supported. These issues are to coverage, quality, and compliance. The findings suggest that iron deficiency and anemia are still major problems in Bangladesh, despite the fact that certain severe deficiencies have been addressed by current intervention efforts. There is a need for more integrated solutions to assist current intervention efforts. Furthermore, new approaches to the management of certain types of iron deficiency anemia are proposed.

Evaluation of possible associated factors for early childhood caries: are preterm birth and birth weight related?

BackgroundThis study aimed to evaluate the oral and dental health of preschool children aged 12–71 months living in the Eastern Anatolia Region of Turkey, and to examine the effects of low birth weight (LBW) and preterm, early term and term birth on dental caries.Methods475 participants were included in the study. Intraoral examinations were performed and evaluated for the presence of early childhood caries (ECC). These values ​​are; Relationships such as age, gender, birth weight, week of birth, tooth brushing frequency, cariogenic nutrition, and parental education levels were examined. The obtained data were analyzed statistically (chi-square, t-test, artificial neural network (ANN)).ResultsOf the 475 participants, whose parents agreed to fill out the questionnaire, 250 were female and 225 were male. While the mean age was 49.78 ± 14.78 months for those with ECC, it was 38.93 ± 17.96 months for those without. Higher duration of breastfeeding (p = 0.04), education level of parents (p = 0.001), lower socioeconomic level (p = 0.001), and lower brushing frequency (p = 0.001) were also found to be significantly associated with ECC. ECC was seen in 90% of 77 children with a history of preterm birth. In LBW, this rate was 83%. According to the ANN result, in preterm birth; 12.9% affected ECC by LBW.ConclusionAccording to the results of our study, both LBW and preterm delivery were found to be associated with ECC and S-ECC (severe early childhood caries). An additional study on parents of preterm/LBW infants would be beneficial. In the early period, regular dental examination, implementation of preventive and preventive treatments, and nutrition education to parents can make a significant difference in the prevention of ECC.

Acquisition of antibodies that block Plasmodium falciparum adhesion to placental receptor chondroitin sulfate A with increasing gravidity in Malian women.

In malaria-endemic areas, pregnant women are more susceptible to Plasmodium falciparum infection, especially primigravidae. During pregnancy, parasites sequester in the placenta and bind to the receptor chondroitin sulfate (CSA). This unique adhesion is mediated by the parasite protein VAR2CSA expressed on the surface of infected erythrocytes (IE). Placental malaria is associated with poor pregnancy outcomes including perinatal mortality, preterm delivery, small for gestational age (SGA) and low birthweight deliveries. Over successive pregnancies, women acquire functional antibodies that inhibit IE adhesion to CSA. Here, we examine the development of anti-adhesion activity and the breadth of anti-adhesion activity as a function of number of previous pregnancies, using samples collected from pregnant women living in an area with high seasonal malaria transmission. Women reached plateau levels of anti-adhesion activity and breadth of anti-adhesion activity after 5 pregnancies. We related the level of anti-adhesion activity and reactivity with surface IE to SGA 19/232 pregnancies resulted in SGA, and report that an increase of 10% in median anti-adhesion activity reduced the odds of SGA by 13% and this relationship approached significance. Further, at an anti-adhesion activity level of 43.7%, an increase of 10% in the breadth of activity significantly reduced the odds of SGA by 21.5%. Antibodies that recognize IE surface increased over successive pregnancies, but were not associated with a reduction in SGA. These results can serve as a guideline for assessing vaccine candidates aiming to reduce poor pregnancy outcomes associated with placental malaria.

Survey of Delivery Outcomes for Employees at MR Imaging Facilities in Japan Based on Information Recorded in the Maternal and Child Health Handbook.

The effect of maternal occupational non-ionizing radiation (NIR) exposure from MRI on premature birth and low birth weight delivery was analyzed based on questionnaire survey (263 employees, 443 births). Although the highest occurrence rates of both outcomes were observed in the group whose NIR exposure occurred only before pregnancy, no statistical significance was detected.

RAPIDIRON Trial follow-up study — the RAPIDIRON-KIDS Study: protocol of a prospective observational follow-up study

BackgroundAnemia is a worldwide problem with iron deficiency being the most common cause. When anemia occurs in pregnancy, it increases the risk of adverse maternal, fetal, and postnatal outcomes. It induces preterm births and low birth weight (LBW) deliveries, long-term neurodevelopmental sequelae, and an increased risk of earlier onset of postnatal iron deficiency. Anemia rates are among the highest in South Asia, and India’s National Family Health Survey (NFHS-5) for 2019–2021 indicated that over half of pregnant women, and more than 65% of children, in the country are classified as anemic (Sciences IIfP, National Family Health Survey-5, 2019–21, India Fact Sheet). In 2021, the parent RAPIDIRON Trial (Derman et al., Trials 22:649, 2021) was initiated in two states in India, with the goal of assessing whether a dose of intravenous (IV) iron given to anemic women during early pregnancy results in a greater proportion of participants with normal hemoglobin concentrations in the third trimester and a lower proportion of participants with LBW deliveries compared to oral iron. As a follow-up to the RAPIDIRON Trial, the RAPIDIRON-KIDS Study will follow the offspring of previously randomized mothers to assess, neurobehavioral, hematological, and health outcomes.MethodsThis prospective observational cohort study will follow a subset of participants previously randomized as part of the RAPIDIRON Trial and their newborns. Study visits occur at birth, 6 weeks, 4 months, 12 months, 24 months, and 36 months and include blood sample collection with both maternal and infant participants and specific neurobehavioral assessments conducted with the infants (depending on the study visit). The primary outcomes of interest are (1) infant iron status as indicated by both hemoglobin and ferritin (a) at birth and (b) at 4 months of age and (2) the developmental quotient (DQ) for the cognitive domain of the Bayley Scales of Infant Development Version IV (BSID-IV) at 24 months of age.DiscussionThis RAPIDIRON-KIDS Study builds upon its parent RAPIDIRON Trial by following a subset of the previously randomized participants and their offspring through the first 3 years of life to assess neurodevelopmental and neurobehavioral (infants, children), hematological, and health outcomes.Trial registrationClinicalTrials.gov NCT05504863, Registered on 17 August 2022. Clinical Trials Registry – India CTRI/2022/05/042933. Registered on 31 May 2022.

Does the Presence or a High Titer of Yellow Fever Virus Antibodies Interfere with Pregnancy Outcomes in Women with Zika Virus Infection?

Zika virus (ZIKV) and yellow fever virus (YFV) originated in Africa and expanded to the Americas, where both are co-circulated. It is hypothesized that in areas of high circulation and vaccination coverage against YFV, children of pregnant women have a lower risk of microcephaly. We evaluated the presence and titers of antibodies and outcomes in women who had ZIKV infection during pregnancy. Pregnancy outcomes were classified as severe, moderate, and without any important outcome. An outcome was defined as severe if miscarriage, stillbirth, or microcephaly occurred, and moderate if low birth weight and/or preterm delivery occurred. If none of these events were identified, the pregnancy was defined as having no adverse effects. A sample of 172 pregnant women with an acute ZIKV infection confirmed during pregnancy were collected throughout 2016. About 89% (150 of 169) of them presented immunity against YFV, including 100% (09 of 09) of those who had severe outcomes, 84% (16 of 19) of those who had moderate outcomes, and 89% (125 of 141) of those who had non-outcomes. There was no difference between groups regarding the presence of anti-YFV antibodies (p = 0.65) and YFV titers (p = 0.6). We were unable to demonstrate a protective association between the presence or titers of YFV antibodies and protection against serious adverse outcomes from exposure to ZIKV in utero.