Maternal Febrile Illness Research Articles

Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance inquiry using cross-sectional study design

BackgroundLow haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin...

Prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa: A multilevel ordinal logistic regression analysis.

Anemia is a major public health problem affecting more than half of children under the age of five globally. It has serious short- and long-term consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Despite anemia is the leading cause of child mortality in sub-Saharan Africa, there is limited evidence on the prevalence and determinants of anemia among under-five children in sub-Saharan Africa. Therefore, this study aimed to investigate the prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa. This study was based on the most recent Demographic and Health Survey (DHS) data of 32 sub-Saharan African countries. A total weighted sample of 135,619 children aged 6-59 months was included in the study. Considering the hierarchical nature of DHS data and the ordinal nature of anemia, a multilevel ordinal logistic regression model was applied. Proportional odds assumption was tested by Brant test and it was satisfied (p-value = 0.091). Besides, deviance was used for model comparison. Variables with a p-value ≤0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel proportional odds model, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported for potential determinant factors of severity levels of anemia. The overall prevalence of anemia among children aged 6-59 months in sub-Saharan Africa was 64.1% [95% CI: 63.9%, 64.4%]. Of which, 26.2% were mildly anemic, 34.9% moderately anemic and 3% severely anemic. Poor maternal education, lower household wealth status, large family size, being male child, multiple births, having fever in the last two weeks, having diarrhea in the last two weeks, higher-order birth, maternal anemia, underweight, wasted, and stunted were significantly associated with increased odds of higher levels of anemia. Whereas, being 24-59 months age, taking drugs for an intestinal parasite, and born from mothers aged ≥ 20 years were significantly associated with lower odds of higher levels of anemia. Severity levels of anemia among children aged 6-59 months in sub-Saharan Africa was a major public health problem. Enhancing maternal education, providing drugs for an intestinal parasite, designing interventions that address maternal anemia, febrile illness, and diarrheal disease, and strengthening the economic status of the family are recommended to reduce childhood anemia. Furthermore, it is better to strengthen the strategies of early detection and management of stunted, wasted, and underweight children to decrease childhood anemia.

Factors Associated with Congenital Heart Diseases among Children in Uganda: A Case-Control Study at Mulago National Referral Hospital (Uganda Heart Institute)

Congenital Heart Diseases (CHD) are among the leading causes of morbidity and mortality associated with congenital malformations among children. Not knowing the risk profile of CHD among children in Uganda impedes development of effective prevention interventions. In this hospital based unmatched case-control study we examined risk factors for all types of CHD among 179 pair of case and control children aged 0-10 years old at Mulago National Referral Hospital. Odds ratios and their corresponding 95% confidence intervals were calculated using multivariate logistic regression. Low birth weight (adjusted OR: 3.15, 95% CI 1.48 - 6.69), high birth order ≥5^th birth order (adjusted OR: 3.69 (1.10 – 12.54), maternal febrile illness during pregnancy, maternal and paternal alcohol consumption, and paternal socio-economic status were associated with CHD. Family history of CHD, maternal education level, maternal chronic illness, and paternal education level were not associated with CHD. The results suggest: low birth weight, high birth order, and maternal febrile illness during pregnancy, parental alcohol use and paternal socio-economic status as dominant risk factors for CHD among children. Rigorous implementation of public health policies and strategies targeting prevention of febrile illness during pregnancy, maternal malnutrition, parental alcohol consumption, delivery of high number of children per woman, might be important in reducing the burden of CHD among children in Uganda.

COVID-19 vaccination during pregnancy.

The morbidity and mortality because of COVID-19 are not specific to age and gender.[1] COVID-19 infection is an extremely contagious disease and it’s reported among asymptomatic and symptomatic patients with various systemic manifestations.[2] Pregnancy is a risk factor for severe COVID-19 patients, especially in women with co-morbidities, resulting in increased rates of preterm birth and maternal morbidity.[3] The rate of COVID-19 in pregnant and recently pregnant women attending or admitted to hospital for any reason was around 10%.[4] Pregnant women with severe and critical SARS-Cov-2 infection had a higher rate of admission in ICU, cesarean delivery, and maternal mortality.[5] Furthermore, COVID-19 causes significant morbidity and mortality among the pregnant women. Moreover, the hospitalization due to respiratory illness required 5%–6% of all SARS-CoV-2–infected pregnant women.[6] The mothers with SARS-Cov-2 infection severity had adverse impacts on fetal outcomes. The severity of infection was associated with higher prevalence of prematurity, need for postnatal resuscitation, increased hospital stay, and extended ventilator support.[7] Vaccination during pregnancy is common to save the mother and her child from various infectious diseases.[3] It is cogent that vaccination will decline the risks of infections so that preference should be given to pregnant women for vaccination.[8] Pregnant women were excluded from the initial phase 3 clinical trials of COVID-19 vaccines, so that limited data are available on the efficacy and safety through antenatal and postnatal period.[9] In a randomized control trial, influenza vaccination was related with a relative decline in maternal febrile influenza-like illness. The positive outcomes were demonstrated following maternal immunization in both early and late pregnancy.[10] The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine have issued guidelines to support the offering of COVID-19 vaccine to gestational women.[11] A study suggested that COVID-19 vaccination during gestation can lead to transfer of antibodies through placenta and breast milk, which may give out immunity to the newborns.[12] The COVID-19 vaccine should be given to pregnant women after communicating the lack of safety data, with privileged administration for those at more risk of severe infection, until safety and efficacy of the vaccines are established.[13] It is well advised that pregnant women and lactating mothers should be vaccinated for better maternal and fetal outcomes.[1] The gestational females with higher risks or co-morbidities predisposing to COVID-19 infection should be prioritized for the vaccination. There is a clear concern about receiving COVID-19 vaccination in pregnancy and lactation, given the lack of efficacy and safety data from available vaccines in the pregnant women.[14] Moreover, the decision of first dose of COVID-19 vaccine should be taken by the pregnant woman but it should be before third trimester.[15] In conclusion, we can say that there is limited data regarding the risk associated with COVID-19 vaccination among pregnant women. By close monitoring of the maternal and fetal findings, we will soon be able to make evidence-based decision and recommendations on efficacy and impact of the vaccination. The population should be counselled about vaccination and involved in risk-benefit discussion. There is limited data available regarding COVID-19 vaccination in pregnant females and lactating mothers. The healthcare professionals have to encourage the women to make an informed decision. Imparting perfect and timely data about COVID-19 vaccination to healthcare professionals, gestational women, and lactating females can enhance vaccine confidence and coverage. Financial support and sponsorship Self funded. Conflicts of interest There are no conflicts of interest.

Cohort profile: molecular signature in pregnancy (MSP): longitudinal high-frequency sampling to characterise cross-omic trajectories in pregnancy in a resource-constrained setting

PurposeA successful pregnancy relies on the interplay of various biological systems. Deviations from the norm within a system or intersystemic interactions may result in pregnancy-associated complications and adverse pregnancy outcomes....

Effect of Chorioamnionitis on Neonatal Outcome: A Hospital-Based Study

Objective: The aim of this study was to determine the impact of chorioamnionitis on neonatal outcome.
 Methods: This cross-section descriptive study was conducted in the neonatal intensive care unit (NICU) of the Department of Pediatrics, Liaquat National Hospital Karachi from June 1st, 2016 to December 31st, 2016. Neonates (infants < 28 days of age) with maternal risk factors indicative of chorioamnionitis (maternal febrile illness in last trimester, high WBC count in maternal blood, lower abdominal pain or tenderness, and foul-smelling discharge) were included in the study. The neonates with an inborn error of metabolism and congenital anomalies were excluded from this study. The neonates were further categorized by gestational age as a term (gestational age >37 weeks) and preterm (gestational age <37 weeks). The neonatal outcome is classified into binary categories; dead or alive. Data were recorded by the data collectors in the predesigned proforma. The data were entered and analyzed using SPSS version 22.
 Results: During the study period, 1200 women delivered a singleton baby, out of which 400 were admitted at NICU. Of 400 infants, a total of 68 neonates of mothers with the indication of chorioamnionitis were enrolled in the study. The mean age of enrolled neonates was 2.55 ± 1.22 days. Out of 68 neonate babies, 33 (48.5%) were males and 35 (51.5%) were females. Only 43 (63%) were delivered, pre-term babies. The morbidities identified were respiratory distress syndrome (33.8%), sepsis (27.9%), intraventricular hemorrhage (10.3%), persistent pulmonary hypertension of newborns (11.8%) and necrotizing enterocolitis (7.4%). A total of 16 (23.5%) neonates died. Out of 16 newborns who died, 32.6% were preterm and 8% were born at term. It was noted that weight, body mass index, fronto-occipital circumference, and gestational age were significant contributors to the mortality.
 Conclusion: In conclusion, chorioamnionitis is an important contributor to neonatal mortality and morbidity. The neonates of a mother with indications of chorioamnionitis are at an increased risk of respiratory distress syndrome.

Self-reported acute febrile illness, malaria and anemia among pregnant women in communities surrounding the Lagoon of Lagos, South-west Nigeria.

Background: Maternal febrile illness is often linked with undesirable adverse consequences of pregnancy and of fetal development. Objective: The objective of this study was to assess the prevalence of malaria parasitemia and anemia among pregnant women who gave a self-report of febrile illness within 48 hours of presentation at antenatal clinics in semi-urban Lagoon communities in Lagos, Southwest Nigeria where malaria preventive strategies have been carried out. Subjects and methods: A total of 113 pregnant women receiving antenatal care at two secondary-level health facilities in Ikorodu Local Government Area of Lagos State, were recruited into this crosssectional. Relevant information such as age, gravidity, trimester of pregnancy, febrile illness within the past 48 hours and use of malaria commodities were extracted from them. Laboratory analysis was conducted for anemia and malaria parasitemia. Results: In all, 32 (28.3%), 32 (28.3%) and 49 (43.4%) of the study subjects were pregnant for the first time, second time and many times respectively. The overall means (± sd) of age (years) and of PCV (%) were 29.9 (5.8) and 30.0 (6.3) respectively while the mean age of those in 1st 2nd and >2 pregnancies were 26.8 (5.2), 27.3 (3.7) and 33.7 (5.1) years respectively. Also, 38 (33.6%) of the 113 study subjects gave a self-report of febrile illness (SERFI) 48 hours prior to presentation at Antenatal clinic. Laboratory investigation showed that 22 (19.5%) of the study subjects were malaria parasite positive, whose mean Packed Cell Volume (26.8 ± 6.6%) was significantly lower (t=2.64, P-value=0.007) than that of the 91 (80.5%) without malaria parasitemia (30.8 ± 6.0%). The mean (± sd) PCV% of the 38 pregnant women who gave a SERFI (28.4 ± 5.2) was significantly lower (t=-2.13, P-value=0.018) than that of the 75 (66.4%) who did not (30.9 ± 6.6). Women in their first pregnancy were over 2½ times as likely to present with febrile illness than those in their second or more pregnancies (χ²=5.36, Pvalue= 0.02, OR=2.65, 995% CI: 1.15, 6.27). In all 36.8%, 27.8% and 40.0% of those in 1st, 2nd and 3rd trimester presented with febrile illness. Very few of the study subjects slept under Long-lasting Insecticide-treated nets (LLINs) night before the survey or used Sulphadoxine-pyrimethamine (SP) for Intermittent Preventive Treatment of malaria in pregnancy (IPTpp). Conclusion: The prevalence of malaria and anemia among those who gave SERFI in pregnancy was moderately high in Ikorodu Local Government Area of Lagos State, Nigeria. More penetrating stronger health education should be given to pregnant women to report within 24-48 hours of any febrile illness in pregnancy. Efforts should also be intensified to identify cause(s) of maternal febrile illness to reduce maternal and neonatal morbidity and mortality in semi-urban settings of Lagos State specifically and throughout Nigeria in general.

Year-round influenza immunisation during pregnancy in Nepal: a phase 4, randomised, placebo-controlled trial

Influenza immunisation during pregnancy is recommended but not widely implemented in some low-income regions. We assessed the safety and efficacy in mothers and infants of year-round maternal influenza immunisation in Nepal, where influenza viruses circulate throughout the year. In this phase 4, randomised, placebo-controlled trial, we enrolled two consecutive sequential annual cohorts of pregnant women from the Sarlahi district in southern Nepal. We randomised mothers 1:1 to receive seasonally recommended trivalent inactivated influenza vaccine or saline placebo in blocks of eight, stratified by gestational age at enrolment (17-25 weeks vs 26-34 weeks). Women were eligible if they were married, 15-40 years of age, 17-34 weeks' gestation at enrolment, and had not previously received any influenza vaccine that season. We collected serum samples before and after immunisation, and cord blood from a subset of women and infants. Staff masked to allocation made home visits every week from enrolment to 6 months after delivery. Midnasal swabs for respiratory virus PCR testing were collected during maternal acute febrile respiratory infections, and from infants with any respiratory symptom. We assessed vaccine immunogenicity, safety, and three primary outcomes: the incidence of maternal influenza-like illness in pregnancy and 0-180 days postpartum, the incidence of low birthweight (<2500 g), and the incidence of laboratory-confirmed infant influenza disease from 0 to 180 days. This trial is registered with ClinicalTrials.gov, number NCT01034254. From April 25, 2011, to Sept 9, 2013, we enrolled 3693 women in two cohorts of 2090 (1041 assigned to placebo and 1049 to vaccine) and 1603 (805 assigned to placebo and 798 to vaccine), with 3646 liveborn infants (cohort 1, 999 in placebo group and 1010 in vaccine group; cohort 2, 805 in placebo group and 798 in vaccine group). Immunisation reduced maternal febrile influenza-like illness with an overall efficacy of 19% (95% CI 1 to 34) in the combined cohorts; 9% efficacy (-16 to 29) in the first cohort, and 36% efficacy (9 to 55) in the second cohort. For laboratory-confirmed influenza infections in infants aged 0-6 months, immunisation had an overall efficacy for the combined cohorts of 30% (95% CI 5 to 48); in the first cohort, the efficacy was 16% (-19 to 41), and in the second cohort it was 60% (26 to 88). Maternal immunisation reduced the rates of low birthweight by 15% (95% CI 3-25) in both cohorts combined. The rate of small for gestational age infants was not modified by immunisation. The number of adverse events was similar regardless of immunisation status. Miscarriage occurred in three (0·2%) participants in the placebo group versus five (0·3%) in the vaccine group, stillbirth occurred in 31 (1·7%) versus 33 (1·8%), and congenital defects occurred in 18 (1·0%) versus 20 (1·1%). Five women died in the placebo group and three died in the vaccine group. The number of infant deaths at age 0-6 months was similar in each group (50 in the placebo group and 61 in the vaccine group). No serious adverse events were associated with receipt of immunisation. Year-round maternal influenza immunisation significantly reduced maternal influenza-like illness, influenza in infants, and low birthweight over the entire course of the study, indicating the strategy could be useful in subtropical regions. Bill & Melinda Gates Foundation.

Determinants of neonatal survival following preterm delivery at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Objective: To study the determinants of neonatal survival and outcome of preterm deliveries at the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Materials and Methods: A retrospective case-control study of women who had preterm delivery (PTD) at the UMTH, Maiduguri from January 1, 2014 to December 31, 2015 was conducted. Information on socio-demographic characteristics, antenatal care and treatment, Apgar score, Special Care Baby Unit (SCBU) and Statistical Package for Social Sciences (SPSS) admission and perinatal mortality were collated. Statistical analysis was done with SPSS. Odd ratio was used to test for association and multiple logistic regression was computed to control for confounding variables at 95% confidence interval. Results: A total of 183 preterm births (with 195 babies) and 183 term births (with 184 babies) having complete information were analyzed. PTD occurred in 10.38% (19/183) of teenage mothers and 31.16% (68/183) of the PTD were before 32 weeks of gestation. Majority of the mothers have had at least basic education (63.69%). The mean duration of admission for the preterm babies was 1.9 + 8.4 days with neonatal survival and take home baby rate being 72.31% (141/195). Neonatal survival was independently associated with gestational age at delivery >32 weeks (OR = 12.24, CI: 5.67–34.76), antenatal dexamethasone (OR = 10.82, CI: 2.38–48.22), pre-labour premature rupture of membranes (OR = 7.68, CI: 1.83–34.64), and delivery after at least 24 hour of commencement of dexamethasone (OR = 5.66, CI: 1.23–45.23). However, maternal febrile illness (OR = 0.25, CI: 0.11–0.56) and polyhydramnious (OR = 0.29, CI: 0.16–0.55) adversely affected neonatal survival. Conclusions: The neonatal survival following PTD is high. Survival is more likely in babies born after 32 weeks, PPROM, and after antenatal dexamethasone. We recommend routine use of antenatal dexamethasone injection in women at risk of PTD and planned delivery at the tertiary centre with equipments to cater for the special needs of the preterm babies.

Congenital Zika Syndrome (CZS) Phenotype Seen in Older Children

BackgroundZika virus (ZIKV) has been documented in Africa since 1947 and Asia since 1969. However, the association of congenital ZIKV infection with microcephaly and serious brain defects was not recognized until a large ZIKV outbreak began in Brazil in 2015. A similar association was retrospectively identified in a 2013–2014 French Polynesian outbreak. In this report, we describe two children, ages 6 (Case 1) and 7 years (Case 2), who display a phenotype consistent with CZS. In both cases, the mothers were residing in Cambodia during their pregnancies (2011 and 2010, respectively); Cambodia has reported ZIKV infections since 2007.MethodsWe review epidemiologic, clinical and laboratory data, and the neurodevelopmental status of these two children.ResultsBoth mothers reported low-grade fever and erythematous rash during their early second trimesters. The infants were born with severe microcephaly (>3 SD below the mean) with central hypotonia and peripheral spasticity (Figure 1). Both had normal karyotypes, negative TORCH results, and neuroimaging suggestive of CZS with subcortical calcifications, polymicrogyria, abnormal corpus callosum, ex-vacuo ventriculomegaly, and reduced white matter (Figure 2). Case 1 had overlapping cranial sutures and redundant scalp (Figure 3). In 2016, serology immunofluorescence assay, immunoglobulin G, and plaque reduction neutralization test for the mother of Case 1 was positive for Zika. Serology for the mother of Case 2 is pending.Presently, both children have severe developmental delays; neither can sit or hold up their head, and both are nonverbal. Case 1 has bilateral hip contractures and hearing loss. Both are visually impaired and require gastrostomy-tube feedings. Case 2 is tracheostomy dependent.ConclusionGiven the maternal febrile rash illness, residence in a ZIKV region during pregnancy, infant features consistent with CZS, and the lack of other identified etiology, CZS should be considered as a possible diagnosis in these cases. It suggests that CZS may have occurred prior to the Brazil and French Polynesia outbreaks. Investigations into neurodevelopmental status of older children with possible CZS can provide insights into the possible long-term effects of CZS.Figure 1Figure 2Figure 3Disclosures All authors: No reported disclosures.

Antenatal risk factors for symptomatic congenital CMV disease following primary maternal CMV infection.

This study aimed to evaluate antenatal risk factors associated with symptomatic congenital cytomegalovirus (CMV) disease, following in utero vertical infection. This study included a retrospective cohort of 155 neonates with congenital CMV infection, following primary maternal CMV infection during pregnancy, and were divided to symptomatic (n=95) and asymptomatic (n=60) newborns. Young maternal age (29.1±5.12 vs. 31.6±5.36 years, P=0.005), high risk occupation for viral exposure (20.0% vs. 11.7%, P=0.04), CMV IgG seroconversion at diagnosis (83.1% vs. 63.3%, P=0.005) and abnormal fetal MRI (11.6% vs. 0%, P=0.003) were found to be prognostic risk factors associated with symptomatic CMV disease of the newborn. Maternal febrile illness at diagnosis, IgG avidity, US findings and the timing of maternal infection were not associated with the occurrence of neonatal symptoms. Knowledge of the reported risk factors may assist in counseling parents with intra uterine CMV infection.

Causes of pediatric cataract in rural population of North India

Aims: To identify the causes of childhood cataract in rural population of north India with special emphasis on potentially preventable causes. Study design: Cross-sectional, observation study. Place and Duration of Study: Department of Ophthalmology, UP University of Medical Sciences, Saifai, India, during December 2014 to November 2015. Methodology: A total of 50 childhood cataract cases (0-15 years age) attending an eye OPD were evaluated including the detailed history comprising age, birth weight, evidence of maternal infection (especially the TORCH infections), rash or febrile illness during pregnancy, any other prenatal and perinatal history that may be pertinent (e.g., alcohol, tobacco, drug use, ionizing radiation exposure during pregnancy), history of ocular trauma, history of corticosteroid therapy and family history. Detailed ocular examination comprising anterior segment examination including morphology of cataract and posterior segment examination under full mydriasis was performed in both eyes, wherever possible. A slit-lamp examination of both the parents was done, that helps to establish the presence of familial cataracts and cataract-associated conditions. Serological investigations such as titers for rubella specific IgM, blood glucose, serum calcium, serum potassium and urine reducing sugars were carried out as indicated. Results: Out of 50 (males 27, females 23) cases, 35 cases (70%) were non-traumatic and 15 cases (30%) were traumatic. Among 35 non-traumatic cases, 17 cases were bilateral and 18 cases were unilateral. For non-traumatic etiology, 9 cases (25.7%) were hereditary, 6 (17.14%) cases were due to congenital rubella syndrome (CRS) and 20 cases (57.14%) were idiopathic. In children under 1 year of age with no history of trauma, 30% cases were due to CRS. In 15 cases of trauma, the cause of trauma was found to be wooden stick in 4 cases(26.6%),thorn injury in 4 cases(26.6%), firecracker injury in 1case(6.6%), cricket ball injury in 4 cas

Foetal congenital anomalies: An experience from a tertiary health institution in north-west nigeria (2011-2013).

Structural or functional defects present at birth may lead to physical or mental disabilities. They contribute significantly to perinatal morbidity and mortality. The study aimed to determine the prevalence of congenital anomalies among women delivering in the labour room suites of a tertiary health institution in North-Western Nigeria. Various maternal risk factors were also correlated and analysed. This was a 3-year hospital-based prospective study carried out in the Department of Obstetrics and Gynaecology in association with the Department of Paediatrics in a tertiary health care centre in North-Western Nigeria. All neonates delivered in the labour rooms were examined for congenital abnormalities (CAs) soon after birth. The study group included all live births along with stillbirths delivered after the 28th week of gestation. Those diagnosed with congenital anomaly were admitted to the special care baby unit for observation and documentation. A total of 72 congenital anomalies were documented among 10,163 deliveries. Central nervous system (CNS) anomalies had the highest prevalence 34.7% (25/72) and were followed by those of the musculoskeletal system 22.2% (16/72). Spina bifida/meningocoele were the most common anomalies of the CNS 44% (11/25) followed by hydrocephaly 28% (7/25). Most of the anomalies involved single organs 59/72 (81.9%). Majority of the CA 84.7% (61/72) were prevalent within the maternal age range of 16-35 years, while 12.5% were seen in teenage pregnancy. Diagnosis of most of the anomalies was made after delivery 69.4% (50/72). History of maternal febrile illness during pregnancy was present in 75% (54/72) and in 50% (27/54) of cases with CNS anomaly. Central nervous system anomalies were the most prevalent congenital anomalies observed. Improved maternal health, pre-conception care, folic acid supplementation and routine foetal anomaly scan may help to reduce these anomalies.

Association of Antepartum and Postpartum Depression in Ghanaian and Ivorian Women With Febrile Illness in Their Offspring: A Prospective Birth Cohort Study

In low-income countries, perinatal depression is common, but longitudinal data on its influence on child health are rare. We examined the association between maternal depression and febrile illness in children. There were 654 mother/child dyads in Ghana and Côte d'Ivoire that were enrolled in a prospective birth cohort in 2010-2011 and underwent 2-years of follow up. Mothers were examined for depression using the Patient Health Questionnaire depression module antepartum and 3 and 12 months postpartum. The hazard of febrile illness in children of depressed and nondepressed mothers was estimated using a recurrent event Cox proportional hazards model. The prevalences of antepartum depression in mothers from Côte d'Ivoire and Ghana were 28.3% and 26.3%, respectively. The prevalences of depression at 3 and 12 months postpartum were 11.8% and 16.1% (Côte d'Ivoire) and 8.9% and 7.2% (Ghana). The crude and adjusted (for country and socioeconomic status) hazard ratios of febrile illness in children of depressed mothers compared with those in children of nondepressed mothers were 1.57 (95% confidence interval: 1.20, 2.07) and 1.32 (95% confidence interval: 1.01, 1.74) respectively. Perinatal depression was frequent and associated with febrile illness in the offspring. Our results showed that a high prevalence of depression in sub-Saharan Africa may pose a serious public health threat to women and their offspring.

Broadening Indications for Maternal Influenza Vaccination

The primary indication for influenza vaccination of pregnant women is to decrease the risk of serious complications during pregnancy [1]. The case fatality rates for pregnant women during the influenza pandemics of 1918 and 1957 ranged from 20% to 50% in various reports [2]. As a consequence, pregnancy— with or without comorbidities—was considered a high-risk condition by the Surgeon General’s Advisory Committee. A large collaborative perinatal project sponsored by the National Institute for Neurological and Communicative Disorders and Stroke from 1959 to 1965 enrolled over 50 000 pregnant women and their offspring who were intensively followed for all events prior to and after delivery found that influenza vaccine administered to 2291 women during pregnancy had no untoward effects [3, 4]. From this study, it can be estimated that about 2 million women received influenza vaccine during pregnancy between 1959 and 1965. Despite the evidence of safety, influenza vaccine was no longer recommended for pregnant women without chronic underlying conditions after 1966 because ‘‘influenza-associated excess mortality among pregnant women has not been documented except in the pandemics.’’ [5]. Reports of influenzarelated deaths continued to occur, and the sensitivity of the data derived from death certificates was questioned [6, 7]. In the early 1990s, investigators looked at risk of influenza-associated hospitalizations during pregnancy and found significant excess occurrence of pneumonia that increased as the pregnancy progressed. This led to reconsideration of the indication for influenza vaccination during pregnancy. In 1995, influenza vaccine was encouraged for all pregnant women who would be in the third trimester during an influenza season [8]. Two years later, all pregnant women in the second or third trimester during an influenza season were recommended to receive influenza vaccine [9]. The recommendation was extended in 2004 to include all pregnant women and women who will become pregnant during the influenza season [10]. It is logical to assume that vaccineinduced maternal immunoglobin G (IgG) antibodies transmitted to the fetus would provide protection for the infant during the first months of life [11]. Protection against all febrile acute respiratory illness and laboratory-confirmed illness was demonstrated in a controlled trial in Bangladesh by Zaman et al. in 2008 [12]. Subsequently, several reports showed reduced influenza-related hospitalizations of infants born to vaccinated women [13–15]. However, the potential benefit of pregnancy vaccination goes beyond prevention of acute respiratory illness in early infancy. An added observation of the Zaman et al. study in Bangladesh was that the infants born to influenzavaccinated women had significantly higher birth weights than those born to women who received the pneumococcal vaccine. In addition, a cohort analysis of Georgia surveillance data showed reduced likelihood of prematurity associated with maternal influenza vaccination [16]. This observation was confirmed by a 13-year retrospective study in Nova Scotia[17], and a prospective study in Rhode Island of women infected with the 2009 pandemic influenza A (H1N1) virus [18]. Coupled with observations of fetal distress occurring with maternal febrile illness leading to premature labor and emergency cesarean section, this provides a broader view of the potential fetal harm resulting from influenza during pregnancy [6]. The report by Bloom-Feshbach et al [19] in this issue of The Journal of Infectious Diseases provides further evidence of the risk of maternal influenza for the fetus. Significant reductions in live births were observed in the United States and Scandinavian countries after the most intense wave of the 1918 pandemic with the nadir of births 6.1 to 6.8 months after the respective peaks of influenza-related mortality. The authors concluded that the observed drop in birth rates was consistent with the concept that infection with the pandemic influenza virus caused first-trimester miscarriages in approximately 10% of pregnant women. The average decline in Received 20 June 2011; accepted 20 June 2011. Correspondence: W. P. Glezen, MD, MVM Department, One Baylor Plaza, MS:BCM-280, Houston, TX, 77030 (wglezen@bcm.edu). The Journal of Infectious Diseases 2011;204:1151–3 The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com 0022-1899 (print)/1537-6613 (online)/2011/2048-0001$14.00 DOI: 10.1093/infdis/jir513

Symptomatic infant characteristics of congenital cytomegalovirus disease in Australia

Human cytomegalovirus (CMV) is the most common cause of viral intrauterine infection. In utero transmission can occur during primary maternal infection, reactivation or reinfection of seropositive mothers. To describe the aetiology and clinical features of infants diagnosed with congenital CMV and to document maternal factors that were presented. Active national surveillance was initiated in 1999 in collaboration with the Australian Paediatric Surveillance Unit. Monthly notifications resulted in 70 cases of congenital CMV being identified between 1999 and 2003. Nearly all of the cases were symptomatic with the most common clinical sequelae reported in infected infants being jaundice, thrombocytopaenia, hepatomegaly, petechiae, purpura and splenomegaly. Almost half (43.5%) of the infants had central nervous system (CNS) complications, such as microcephaly, chorioretinitis, sensorineural hearing loss, intracranial calcifications, developmental delay or seizures, with over half presenting two or more CNS abnormalities. Maternal febrile illness was noted in 54.8% of the cases. The majority of mothers were primiparous (46.4%) or secundiparous (39.3%), indicating two different population groups at risk of primary CMV infection. This study documents symptomatic congenital CMV cases in Australia.

Maternal illness, including fever and medication use as risk factors for neural tube defects.

We investigated if selected maternal illnesses or medications used during the periconceptional period increased risk of having neural tube defect (NTD)-affected pregnancies. We used a population-based case-control study of fetuses and liveborn infants with NTDs among 1989-1991 California births. In-person interviews were conducted with mothers of 538 (88% of eligible) NTD cases and 539 (88%) nonmalformed controls, usually within 5 months of delivery. A maternal fever or febrile illness episode in the first trimester was associated with an increased risk for having a NTD-affected pregnancy, odds ratio (OR) = 1.91 (95% confidence interval, 1.35-2.72) for fever and OR = 2.02 (1.20-3.43) for febrile illness. Risk estimates were not substantially altered after adjustment for maternal age, race/ethnicity, education, vitamin use, and body mass index. Other reported illnesses were generally not associated with risks of 1.5 or greater, or were too infrequent to adequately estimate risk. An OR of 1.5 or greater was observed for maternal use of guaifenesin, OR = 2.04 (0.79-5.28), and an OR of 0.5 or less was observed for maternal use of calcium-containing medicines, OR = 0.38 (0.14-1.03). Our findings are consistent with previous reports that suggested elevated NTD risks from maternal fever. We could not discriminate, however, whether the increased risks observed for maternal fever were indicative of a causal relation or due to reporting bias. Our findings suggest that many of the illnesses common to reproductive-aged women and the medications commonly used to treat them during pregnancy, except, perhaps, for those illnesses that are febrile-related, do not appear to substantially contribute to the occurrence of NTDs in the population.

An epidemiological study of congenital malformations in newborn.

In a prospective study of 3000 consecutive deliveries (14 twin deliveries), the rate of congenital malformation was reported to be 27.20 per 1000 births (82 out of 3014). No significant difference was observed in the frequency of congenital malformation in urban rural status, in different religion and caste, and in male female babies. An increase in frequency was seen in advanced maternal age and in primi and fourth gravida mothers. A number of environmental factors studied, such as use of different tooth powders, type of drinking water, different cooking vessels, associated vitamin deficiencies did not seem to influence the prevalence of birth defects significantly. The factors which significantly increased the rate of congenital malformation were consanguinity in parents, heredofamilial history of malformations, presence of hydramnios, maternal febrile illness in first trimester, past history of abortion and history of progesterone intake during pregnancy.

Neural tube defects and maternal hyperthermia in early pregnancy: epidemiology in a human embryo population.

A causal relationship between neural tube defects and maternal febrile illness in early pregnancy was investigated retrospectively using human embryo data from Japan. The frequency of febrile illness was compared with corresponding data from normal controls, and holoprosencephalic and polydactylous embryos. Within the group of neural tube defects, the prevalence of maternal hyperthermia was significantly higher than in normal control and holoprosencephaly mothers. The association was constant and highly significant specifically for exencephaly, which is an embryonic forerunner of anencephaly. The correlation with myeloschisis (without exencephaly) was not significant. In eight out of the ten cases in which the timing of the fever was known, it occurred during the clinically determined critical period of neural tube closure in human embryos. These results support the hypothesis that maternal hyperthermia in early pregnancy can cause neural tube defects in man, especially anencephaly.

T-strains of mycoplasma in bronchopneumonic lungs of an aborted fetus.

VARIOUS types of mycoplasma have been found associated with spontaneous abortions during the last few years. Clinical conditions in which they have been observed include premature deliveries with accompanying maternal febrile illness,1 , 2 premature rupture of placental membranes3 , 4 and cases with a history of recurrent reproductive failure. Verifying the effect of mycoplasmas infecting aborted and malformed fetuses, we recovered a T-strain of mycoplasma from the placenta and from the heart and lung of a fetus with intrauterine bronchopneumonia in the fifth month of pregnancy. Materials and Methods Collection of Internal Organs The aborted fetus was carefully opened, and pieces of internal . . .