Maternal Sociodemographic Variables Research Articles

Consumption of non-nutritive sweeteners by pre-schoolers of the food and environment Chilean cohort (FECHIC) before the implementation of the Chilean food labelling and advertising law

BackgroundConsumption of non-nutritive sweeteners (NNS) is becoming increasingly more frequent, particularly in the context of obesity prevention policies. The aim of this study was to describe the consumption of NNS in an ongoing cohort of pre-schoolers (4–6-year-old) before the implementation of the Chilean Food Labelling and Advertising Law, identify sociodemographic and anthropometric characteristics associated with their consumption, and describe the main dietary sources of each NNS sub-type.MethodsIn 959 low-medium income pre-schoolers from the Food and Environment Chilean Cohort (FECHIC), dietary data from a single 24-h recall was linked to NNS content information obtained from packaged foods (n = 12,233). The prevalence of NNS consumption was estimated by food source and characterized by child and maternal sociodemographic and anthropometric variables. Intakes and main dietary sources were described for the six most prevalent NNS in Chile: Sodium Cyclamate, Saccharin, Aspartame, Acesulfame Potassium, Sucralose, and Steviol glycosides.ResultsSixty-eight percent of the pre-schoolers consumed at least one source of NNS on the day of the dietary recall; most of them consumed NNS from foods and beverages (n = 532), while only 12% (n = 119) also consumed table-top sweeteners. The prevalence of NNS consumption was significantly higher among children whose mothers had a high educational level compared to children whose mothers did not complete high school (p < 0.05); however, it did not differ by any other variable studied. The highest intakes of NNS were observed for Aspartame [2.5 (1.4–3.7) mg/kg per consumer], followed by Sodium Cyclamate [1.6 (1.3–2.6) mg/kg per consumer] and Steviol glycosides [1.2 (0.2–2.1) mg/kg per consumer]. Beverages were the only food group that contributed to the intake of the six NNS studied, accounting for 22% of the overall intake of Saccharine and up to 99% of Aspartame intake.ConclusionsBefore the implementation of the Food Labelling and Advertising Law, NNS consumption was highly prevalent among a cohort of low-middle income Chilean pre-schoolers. Continuous monitoring of NNS consumption is essential given potential food reformulation associated with the implementation of this set of obesity-prevention policies.

Profile of Prenatally Diagnosed Major Congenital Malformations in a Teaching Hospital in Nigeria

Background: Prenatal diagnosis of major congenital abnormality is one of the main goals of antenatal care, because of its contribution to perinatal morbidity and mortality. Awareness of the profile in terms of rates and spectrum could aid management and prevention strategies. This study aims to determine the profile of congenital malformations, and the relationship between the rates and some maternal socio-demographic and obstetric variables.&#x0D; Methods: A retrospective cross-sectional study of prenatally diagnosed congenital malformations in singleton pregnancies over a four-year period. The ultrasound scan findings and the findings of fetal ultrasonography, together with maternal socio-demographic and obstetric variables, were collected from the ultrasound scan reports or medical records of each pregnancy. Data were analyzed using Microsoft Excel 2010.&#x0D; Results: Among the 968 singleton pregnancies, 78 had major congenital malformation, giving an antenatal rate of 8.04/1000 (0.8%). The first trimester prevalence was comparable with other trimesters. Malformation mostly involved single systems (93.6%), which are mainly central nervous (48.7%) and gastrointestinal/abdominal systems (21.8%). The rate was statistically significant (&lt; 0.0018) in women aged &gt; 35 years. The mean maternal age and parity were 31.4 + 4.7 and 2.8 + 0.4, respectively. The rates of congenital malformation in spontaneously or assisted conceptions were not statistically significant (p = 0.073 and p = 0.085).&#x0D; Conclusion: Maternal age &gt; 35 years and multiparity are important risk factors for congenital malformation. The commonly involved systems are the central nervous and gastrointestinal systems.&#x0D; Keywords: congenital malformations, prevalence, spectrum, antenatal ultrasound scan, Nigeria

Breastfeeding self efficacy among pregnant women in Saudi Arabia

Objectives:To examine the association between prenatal breastfeeding self-efficacy among Saudi pregnant women and type of feeding at 4 weeks post partum, and also to examine the association of maternal socio-demographic variables with the breastfeeding self-efficacy levels of Saudi pregnant women.Methods:A cross-sectional design has been applied in the study by recruiting 101 pregnant women from the General Hospital, Umluj, Kingdom of Saudi Arabia. The prenatal breastfeeding self-efficacy scale was used to measure self-efficacy for breastfeeding during pregnancy. Descriptive statistics, Chi-square, Pearson correlation coefficient were used for statistical purposes. A p-value ≤0.05 was considered significant.Results:The average breastfeeding self-efficacy score was 70±11.9. No significant relationship was existed between breastfeeding self-efficacy and the maternal sociodemographic variables. A significant relationship was found between type of feeding at 4 weeks postpartum and prenatal breastfeeding self-efficacy (r=0.061, p<0.05). Women who exclusively breastfeed their babies had high scores on prenatal breastfeeding self-efficacy scale than those who mixed feed or bottle feed their infants.Conclusion:Levels of prenatal breastfeeding self-efficacy among Saudi pregnant women were high and can be predictive of breastfeeding exclusivity at 4 weeks postpartum. The prenatal breastfeeding self-efficacy could be used to measure whether the woman could organize and execute the causes of action needed to perform breastfeeding behavior.

A population-based case-control study of the association between weather-related extreme heat events and orofacial clefts.

Limited epidemiologic research exists on the association between weather-related extreme heat events (EHEs) and orofacial clefts (OFCs). We estimated the associations between maternal exposure to EHEs in the summer season and OFCs in offspring and investigated the potential modifying effect of body mass index on these associations. We conducted a population-based case-control study among mothers who participated in the National Birth Defects Prevention Study for whom at least 1 day of their first two post-conception months occurred during summer. Cases were live-born infants, stillbirths, and induced terminations with OFCs; controls were live-born infants without major birth defects. We defined EHEs using the 95th and the 90th percentiles of the daily maximum universal apparent temperature distribution. We used unconditional logistic regression with Firth's penalized likelihood method to estimate adjusted odds ratios and 95% confidence intervals, controlling for maternal sociodemographic and anthropometric variables. We observed no association between maternal exposure to EHEs and OFCs overall, although prolonged duration of EHEs may increase the risk of OFCs in some study sites located in the Southeast climate region. Analyses by subtypes of OFCs revealed no associations with EHEs. Modifying effect by BMI was not observed. We did not find a significantly increased risk of OFCs associated with maternal exposure to EHEs during the relevant window of embryogenesis. Future studies should account for maternal indoor and outdoor activities and for characteristics such as hydration and use of air conditioning that could modify the effect of EHEs on pregnant women.

Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the Demographic and Health Survey, 2012\u201313

BackgroundThe increasing rate of caesarean deliveries has become a serious concern for public health experts globally. Various medical and non-medical factors, such as maternal socio-demographics, are found to be responsible for this upsurge. Like in other countries, the rate of caesarean sections has increased in Pakistan as well. Therefore, there is a need to investigate the factors behind this increase. This study aims to assess the determinants associated with caesarean deliveries among child-bearing women aged 15–49 years in Pakistan.MethodsSecondary data analysis was conducted on nationally representative cross-sectional survey data from the Pakistan Demographic and Health Survey, 2012–2013. The analysis was limited to mothers aged 15–49 years, who had given birth to at least one child during the 5 years immediately preceding the survey (n = 7461). Maternal socio-demographic characteristics and pregnancy-related variables, including antenatal care utilisation, place of delivery and pregnancy complications were considered as independent variables. The association between caesarean section deliveries (outcome variable) and its determinants was assessed by calculating unadjusted and adjusted odds ratios with 95% confidence intervals using a multivariable binary logistic regression.ResultsOf the women who had given birth to at least one child during the previous 5 years, the percentage of mothers who delivered their babies through caesarean section was found to be 13.6%. The likelihood of caesarean deliveries was associated with mothers aged more than 24 years, women residing in Punjab province, women belonging to the richest class, women with higher education, women employed at professional/managerial/technical level, and women residing in an urban setting. Additionally, the women who had pregnancy complications, a high utilisation of antenatal care and delivered their babies in private hospitals were found to have higher chances of caesarean deliveries.ConclusionsThe study revealed that there are a high percentage of women delivering babies through caesarean section in Pakistan. Therefore, strict measures need to be taken to deal with this concern. For example, detailed medical justifications by doctors for performing caesarean sections and awareness among women regarding the reduction of pregnancy complications can help to reduce the chances of malpractice related to caesarean deliveries.

Maternal risk factors of perinatal mortality in Duhok

Background: Perinatal mortality (PM) rate is an important index of community health condition. A high-risk pregnancy is one that threatens the health or the life of the mother and her fetus, during or after the pregnancy and birth. Objective: This study aimed to identify the etiological maternal risk factors and other causes that lead to PM, to calculate the PM rate (PMR) in maternity hospital in Duhok, and to compare it with the previous rates, and to find out the relationship between maternal socio-demographic and obstetrics variables with PMR. Materials and Methods: During the study, which was from January to December 2013, the total deliveries were 20281, and the perinatal deaths were 496 cases. Results: The PMR was (24.5%/1000 births), the number of early neonatal deaths were 268 (54%), and it is higher than stillbirths deaths (fresh and macerated). The most common causes and associated risk factors behind the fresh stillbirths (30.5%). Macerated stillbirths 77 (15.5%), were the main causes of death. The most causes of early neonatal deaths were birth asphyxia (36.6%) and prematurity (34.3%). It was found that most important maternal risk factors for PM are preeclampsia, and obstructed labor. The results of the study revealed a significant association between mother's level of education, occupation, residential area, antenatal care, gestational age, parity, and PM, but revealed a nonsignificant association between the mother's age and PM. Conclusions: There was a significant relation between maternal risk factors and PM, the early diagnosis of these risk factors decreased the PM. The PMR was 24.5/1000 total births in 2013, at a maternity hospital in Duhok, It was lower than that of 2004 and 2005. Most of the PM were in the groups of poor antenatal care and their residence from the rural area.

Attitude and awareness of expectant and lactating mothers toward infant oral health care in North Indian subpopulation: A cross-sectional study

Introduction: Mothers play a key role in adoption of preventive strategies for an improved oral health in the first few crucial years of life of infants and young children. The purpose of the study is 2 folds: (1) to evaluate and compare the awareness and attitude (Aw-At) levels between expectant and lactating mothers toward infant oral health care and (2) to analyze the influence of maternal sociodemographic variables on their Aw-At levels toward infant oral health care. Materials and Methods: A total of 500 expectant and lactating mothers visiting the outpatient department of the government hospital in Rohtak, India, were randomly selected and interviewed through a 27-item self-designed, structured questionnaire. Mann–Whitney, Kruskal–Wallis, and Chi-square tests were applied for assessment and comparison. Results: Lactating mothers scored significantly higher than expectant mothers (P = 0.004) in awareness levels. Awareness score of mothers (26–35 years old) was also significantly higher than the younger ones (P = 0.002). Urban group had a higher attitude score than rural group mothers (P = 0.002). Working mothers scored more in both Aw-At scores (P Conclusion: The study had found low awareness levels toward infant oral health care but a positive attitude among mothers. Hence, it is suggested to increase this to ensure optimal dental health for themselves and their children by educating and motivating the mothers, providing prenatal counseling, anticipatory guidance, referral by the medical personnel, and most importantly, establishing the concept of dental home.

Elevated maternal anxiety in the NICU predicts worse fine motor outcome in VLBW infants

AimThe literature is sparse with respect to the impact of elevated maternal psychological distress in the neonatal intensive care unit (NICU) on later neurodevelopmental outcome in VLBW infants. The objective of this study is to examine the impact of elevated maternal distress, defined as elevated depression, anxiety and perinatal-specific post-traumatic stress, during the NICU hospitalization on VLBW infant ND outcome at 20months corrected age (CA). MethodsThis was a prospective study of 69 mothers and their VLBW infants recruited in 2011–2012. Elevated maternal distress was collected by maternal questionnaire in the NICU. Elevated depression was quantified with the Center for Epidemiological Studies-Depression Scale, anxiety with the Spielberger State-Trait Anxiety Inventory and perinatal-specific post-traumatic stress with the Modified Perinatal Posttraumatic Stress Disorder Questionnaire. VLBW infant ND outcome was assessed using the Bayley Scales of Infant & Toddler Development-III at 20months CA. Regression analyses determined the impact of elevated distress on ND outcome after adjusting for infant medical and maternal sociodemographic variables. ResultsAfter controlling for infant and maternal covariates, elevated maternal anxiety in the NICU predicted lower fine motor scores at 20months CA. ConclusionElevated maternal anxiety in the NICU is associated with adverse ND outcome in VLBW infants in the 2nd year of life. NICU-based support services may help mothers' quality of life and VLBW infant outcome.

Gestational, perinatal, and postnatal factors that interfere with practice of exclusive breastfeeding by six months after birth

BackgroundDespite evidences indicating the superiority of breastfeeding and recent advances in the indicators of breastfeeding in Brazil, exclusive breastfeeding (EBF) during the first six months after birth continues to be an infrequent practice in the country. The objective of the present study was to determine which gestational, perinatal, and postnatal factors of the mother-baby dyad might be associated with the cessation of EBF by six months after birth.MethodsData were collected at the rooming-in facility of the Reference Center of Women’s Health of Ribeirão Preto-Mater (CRSM-Mater) during the postpartum period (24 to 72 h after birth) from December 2012 to April 2013 and by telephone contact between the researcher and participating mothers by six months after birth.Questionnaires were applied to collect data, such as the practice of EBF in the last 24 h in the sixth month after birth. The hierarchical theoretical model was proposed and data were analyzed statistically by log-binomial regression models using SAS 9.3.ResultsThe study involved 283 mother-baby dyads in which the mother evaluated did not present pregnancy-puerperal complications that could impede breastfeeding and confirmed the interest in breastfeeding her child. After the telephone contact in the exact sixth month after the birth of each participating baby, 84.8% of the participating mothers reported that they were no longer exclusively breastfeeding their babies. After statistical analysis, we found that there was a significant association between cessation of EBF and maternal report of previous experience with EBF for one month (0.91, 95% CI 0.81, 0.99) and six months (0.81; 95% CI 0.68, 0.94). These practices were associated with the maintenance of EBF and, even after adjustment for maternal socio-demographic variables, this association was maintained (0.85; 95% CI 0.73, 0.99). Thus, there is a greater chance of practicing and maintaining EBF by six months after birth when mother had previous experience with it.ConclusionThe identification of the risk variables associated with cessation of EBF by six months postpartum, such as previous experience with exclusive breastfeeding, may contribute to the effectiveness of EBF intervention and support measures during the first six months after birth.

The role of sociodemographic factors in maternal psychological distress and mother-preterm infant interactions.

Preterm birth has been associated with greater psychological distress and less positive mother infant interactions than were experienced by mothers of full-term infants. Maternal and infant sociodemographic factors have also shown a strong association with psychological distress and the mother-infant relationship. However, findings on their effects over time are limited. In this longitudinal analysis, we explored the relationship of maternal and infant sociodemographic variables (maternal age, maternal education, marital status, being on social assistance, maternal race, infant birth weight, and infant gender) to maternal psychological distress (depressive, posttraumatic stress, anxiety, parenting stress symptoms, and maternal worry about child's health) through 12 months corrected age for prematurity, and on the home environment, and mother-infant interactions through 6 months corrected age for prematurity. We also explored differences related to maternal obstetrical characteristics (gestational age at birth, parity, mode of delivery, and multiple birth) and severity of infant conditions (Apgar scores, need for mechanical ventilation, and infant medical complications). Although the relationship of maternal and infant characteristics with these outcomes did not change over time, psychological distress differed based on marital status, maternal education, infant gender, and infant medical complications. Older mothers provided more a positive home environment. Mother-infant interactions differed by maternal age, being on public assistance, maternal race, infant gender, and infant medical complications. More longitudinal research is needed to better understand these effects over time in order to identify and support at-risk mothers.

Factors associated with the quality of life of mothers of preterm infants with very low birth weight: a 3-year follow-up study.

To analyze possible factors associated with the quality of life (QoL) of mothers of preterm infants with very low birth weight (VLBW) during the first 3years after delivery. The World Health Organization Quality of Life (WHOQOL)-bref scores were compared and correlated with maternal and infant-related sociodemographic and clinical variables at maternal discharge (T0) and at 6 (T1), 12 (T2), 24 (T3), and 36 (T4) months after delivery. Multiple linear regression models were fitted to investigate the effect of these variables on the mothers' QoL. The WHOQOL-BREF physical domain scores were higher at T1 and T2 compared to T0 (p=0.013). Maternal variables that contributed to maternal QoL scores (p<0.05) were stable marital union (b=13.60; T0), family income (b=-12.75; T3), Evangelical religion (b=8.11; T4), and beck depression inventory (BDI) score (-1.42≤b≤-0.36; T0, T1, T2, T3, and T4). Infants' variables that most affected maternal QoL (p<0.05) were posthemorrhagic hydrocephalus (PHH) (-18.84≤b≤-10.05; T1, T2, and T4), bronchopulmonary dysplasia (BPD) (b=-7.41; T2), female gender (b=8.09; T2), and SNAPPE severity score (b=-0.23; T3). Mothers of preterm infants with VLBW exhibited transient improvements in physical well-being during the first year after delivery. The presence of depressive symptoms in mothers and the diagnosis of PHH or BPD were negatively associated with QoL. Social, religious, and economic aspects were also important factors for the QoL of mothers of preterm infants with VLBW.

Greater early and mid-pregnancy gestational weight gains are associated with excess adiposity in mid-childhood.

It is unclear how specific periods of gestational weight gain (GWG) during pregnancy relate to childhood adiposity. The goal of this study was to assess the differential impact of GWG timing on childhood body composition. In 979 mother-child pairs from the pre-birth Project Viva cohort, trimester-specific GWG was calculated using clinically recorded weights. Outcomes included body mass index (BMI) z-score, dual X-ray absorptiometry fat mass index (kg/m(2) ), and fat-free mass index (kg/m(2) ) in mid-childhood. Linear regression models were used to assess associations of each trimester's GWG (per 0.2 kg/week) with childhood outcomes, adjusted for maternal prepregnancy BMI, sociodemographic variables, lifestyle, and GWG in prior trimester(s). Mean (SD) first trimester GWG was 0.22 (0.22) kg/week, second trimester 0.49 (0.18) kg/week, and third trimester 0.47 (0.20) kg/week. Faster first trimester GWG was associated with higher BMI z-score (0.06 units [95% CI: 0.01-0.12] per 0.2 kg/week) and with higher adiposity according to all indices; associations were strongest in women with prepregnancy BMI >30 kg/m(2) . Faster second trimester GWG was associated with higher BMI z-score (0.11 [0.04-0.18]), fat mass (fat mass index = 0.16 [0.02-0.31] kg/m(2) ), and lean mass (fat-free mass index = 0.11 [0.01-0.22] kg/m(2) ). Third trimester GWG was not associated with childhood adiposity. These results reinforce the importance of addressing appropriate GWG in early pregnancy.

Dietary Pattern Trajectories from 6 to 12 Months of Age in a Multi-Ethnic Asian Cohort.

Little is known about the dietary patterns of Asian infants in the first year of life, nor of their associations with maternal socio-demographic factors. Based on the Growing Up in Singapore towards healthy Outcomes (GUSTO) mother-offspring cohort, cross-sectional dietary patterns were derived by factor analysis using 24-h recalls and food diaries of infants at 6-, 9- and 12-months of age. Dietary pattern trajectories were modeled by mapping similar dietary patterns across each age using multilevel mixed models. Associations with maternal socio-demographic variables, collected through questionnaires during pregnancy, were assessed using general linear models. In n = 486 infants, four dietary pattern trajectories were established from 6- to 12-months. Predominantly breastmilk: mainly breastmilk and less formula milk, Guidelines: rice porridge, vegetables, fruits and low-fat fish and meat, Easy-to-prepare foods: infant cereals, juices, cakes and biscuits and Noodles (in soup) and seafood: noodle and common accompaniments. In adjusted models, higher maternal education attainment was correlated with higher start scores on Predominantly breastmilk, but lowest education attainment increased its adherence over time. Older mothers had higher start scores on Easy-to-prepare foods, but younger mothers had increased adherence over time. Chinese mothers had higher start scores on Predominantly breastmilk but greater adherence to Guidelines over time, while Indian mothers had higher start scores on Easy-to-prepare foods but greater adherence to Predominantly breastmilk with time (p < 0.05 for all). Changes in trajectories over time were small. Hence, dietary patterns established during weaning are strongly influenced by maternal socio-demographic factors and remain stable over the first year of life.

Neonatal Death Rates: Lack of Equal Access to Hospital Obstetric Service and Intensive Therapy

Aim: To identify the association between access to obstetric and neonatal hospital service and neonatal death rates. Method: Quantitative and retrospective research retrieved from Declaration of Live Newly-born Children; Declaration of Death; Investigation Chart on Municipal Child Mortality, between 2000 and 2009, at the Nucleus of Information on Mortality Rates. The population studied comprised 537 neonatal deaths and mothers with residence in the municipality, and investigated by the work team of the Committee for the Investigation of Mother-Child Deaths. Data were analyzed in Epi Info 2002 ® computer program and the Statistical Package for the Social Sciences ® was used. Chi-square Test and Fischer’s Exact Test were applied at p < 0.05. Results: 63.7% of 537 neonates were born in hospitals with maternities and neonatal intensive therapy unit; 60.7% weighed ≤1.500 grams; 76.7% had a pregnancy age of ≤36 weeks; 73% died of asphyxia in the 1st minute and 73.5% died during the perinatal period. Throughout the ten years of analysis, access to hospital obstetric service without NITU reduced death rate from 25% in 2000 to 6.8% in 2009. There was a significant statistical association between place of delivery and maternal socio-demographic variables (maternal age bracket p = 0.028; schooling p = 0.000; family income p = 0.000); occupation p = 0.000) and neonatal variables (race/skin color p = 0.007; type of delivery p = 0.000; weight at birth p = 0.000; pregnancy age p = 0.000 and Apgar Score 1st minute p = 0.000 and Apgar Score 5 th minute p = 0.007). Conclusion: Although the municipal government provides obstetric services and specialized neonatal care, this right is not extensive to all; gaps at different * Corresponding author.

Protein and Micronutrient Intakes Are Associated with Child Growth and Morbidity from Infancy to Adulthood in the Philippines

Background: Interactions between nutrition and infections in developing countries are complex, and analyses of the interrelations require data from longitudinal studies that span several years and a comprehensive framework facilitating the formulation of food and health policies.Objective: The effects of dietary intakes in the Philippines for birth outcomes, heights, weights, and morbidity during ages 2–24 mo; heights and weights during ages 8–19 y; and completed adult heights were analyzed.Methods: Data on >3000 children from the Cebu Longitudinal Health and Nutrition Survey were modeled in 4 sets of analyses. Cross-sectional and multilevel models were estimated for length and weight at birth. Dynamic random-effects models were estimated for children's heights, weights, and morbidity levels during ages 2–24 mo. Children's heights and weights during ages 8–19 y were modeled by using random-effects models. Children's heights at age 22 y were modeled for investigating the effects of nutritional intakes in early childhood and in adolescence.Results: Maternal anthropometric indicators, energy intakes, and sociodemographic variables were significantly associated with children's length and weight at birth. Dynamic models for children's heights and weights during ages 2–24 mo showed significant effects of calcium and protein intakes; child morbidity levels were significantly associated with height and weight. Higher β-carotene intakes were significantly associated with lower morbidity levels. Analyses of data on children during ages 8–19 y showed significant effects of protein and calcium intakes and of morbidity levels on heights and weights. Models for children's heights at age 22 y indicated significant effects of protein and calcium intakes during early childhood and in adolescence.Conclusions: The results underscored the need for formulating long-term food and health policies for the Philippines that enhance children's physical development and ultimately their adult stature, which is important for physical work capacity and labor productivity.

Birth outcomes of patients with isolated anorectal malformations: A population-based case-control study.

In most patients affected by isolated anorectal malformation (IARM) the etiology is largely unknown. Thus, the aim of our project was to analyze possible risk factors for IARM. In the first step, birth outcomes of cases with IARM were analyzed on the basis of maternal socio-demographic variables, and these data are presented in this paper. Gestational age at delivery, birthweight, preterm birth, low birthweight and small for gestational age of cases with IARM were evaluated in the function of maternal age, birth/pregnancy order, marital and employment status of mothers in the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996. The study samples included 231 live-born cases with IARM, 361 matched and 38 151 population controls without any defect. IARMs are more frequent in males, twins and newborn infants with low birthweight and small-for-gestational-age, the latter being the consequence of intrauterine growth restriction. In addition, mothers of cases were younger but with higher birth order, and had lower socio-economic status. These maternal variables are characteristic for the gypsy population in Hungary. The higher proportion of gypsy women among the mothers of cases with IARM was confirmed during the home visits of the study. Male sex and intrauterine growth restriction of cases, in addition to low socioeconomic status and gypsy origin of mothers may have a role in the risk of IARMs.

Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus.

Maternal dietary patterns before and during pregnancy play important roles in the development of gestational diabetes mellitus (GDM). We aimed to identify dietary patterns during pregnancy that are associated with GDM risk in pregnant U.S. women. From a 24 h dietary recall of 253 pregnant women (16–41 years) included in the National Health and Nutrition Examination Survey (NHANES) 2003–2012, food items were aggregated into 28 food groups based on Food Patterns Equivalents Database. Three dietary patterns were identified by reduced rank regression with responses including prepregnancy body mass index (BMI), dietary fiber, and ratio of poly- and monounsaturated fatty acids to saturated fatty acid: “high refined grains, fats, oils and fruit juice”, “high nuts, seeds, fat and soybean; low milk and cheese”, and “high added sugar and organ meats; low fruits, vegetables and seafood”. GDM was diagnosed using fasting plasma glucose levels ≥5.1 mmol/L for gestation <24 weeks. Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (CIs) for GDM, after controlling for maternal age, race/ethnicity, education, family poverty income ratio, marital status, prepregnancy BMI, gestational weight gain, energy intake, physical activity, and log-transformed C-reactive protein (CRP). All statistical analyses accounted for the appropriate survey design and sample weights of the NHANES. Of 249 pregnant women, 34 pregnant women (14%) had GDM. Multivariable AOR (95% CIs) of GDM for comparisons between the highest vs. lowest tertiles were 4.9 (1.4–17.0) for “high refined grains, fats, oils and fruit juice” pattern, 7.5 (1.8–32.3) for “high nuts, seeds, fat and soybean; low milk and cheese” pattern, and 22.3 (3.9–127.4) for “high added sugar and organ meats; low fruits, vegetables and seafood” pattern after controlling for maternal sociodemographic variables, prepregnancy BMI, gestational weight gain, energy intake and log-transformed CRP. These findings suggest that dietary patterns during pregnancy are associated with risk of GDM after controlling for potential confounders. The observed connection between a high consumption of refined grains, fat, added sugars and low intake of fruits and vegetables during pregnancy with higher odds for GDM, are consistent with general health benefits of healthy diets, but warrants further research to understand underlying pathophysiology of GDM associated with dietary behaviors during pregnancy.

Delays in healthcare delivery to sick neonates in Enugu South-East Nigeria: an analysis of causes and effects

In most parts of the world, neonatal mortality rates have shown a slower decline when compared with under-5 mortality decline. A sick newborn can die within minutes if there is a delay in presentation, thus early diagnosis and treatment are essential for the survival of a critically ill newborn. This study investigated factors responsible for delays in healthcare services for the sick newborn and maternal socio-demographic variables that influence these delays in Enugu, South-East Nigeria. This was a community-based descriptive study. A total of 376 respondents were randomly selected from 4 of the 17 local government areas of Enugu State. Mothers and/or caregivers that were nursing or had nursed a child in the previous 2 years were enrolled. Self-reported data on delays encountered during healthcare for sick newborn were collected using pretested structured questionnaire. Chi-square and multivariate logistic regression were used to determine the association between causes of delays in newborn healthcare services, maternal socio-demographics and relationships with newborn mortality. Delays in reaching healthcare facilities accounted for the most common delays encountered by respondents, 78.0%, in this study, followed by delays at household level, 24.2% and delays at health facility level 16.0% (P = 0.000). Mothers with knowledge of ≥3 WHO recognized danger signs compared with those with ≤2 were significantly less likely to delay at household (level 1: 40.7 versus 59.3%) (P = 0.017) and reaching healthcare service (level 2: 19.9 versus 80.1%) (P = 0.028). Delays at health facility level (level 3) occurred more at tertiary health facilities (59.0%), secondary health facilities (39.1%) and primary healthcare facilities (19.7%) compared with private health facilities (13.5%) (P = 0.000). Delays in seeking healthcare at all levels especially those related to transporting the sick newborn to the hospital are a contributor to newborn mortality in Nigeria. Improving access to healthcare could potentially reduce mortality in the sick newborn.

Knowledge of danger signs in newborns and health seeking practices of mothers and care givers in Enugu state, South-East Nigeria.

BackgroundAccording to UNICEF, 40% of all under-5 deaths occur within the first month of life and half of these within the first few days of life. Many of these deaths are related to late recognition of neonatal illness, delays in decision to seek care at household level and subsequent late intervention at healthcare facilities. Knowledge of mothers about the danger signs in newborn is imperative to reduce these delays and preventable deaths.AimThis study aimed to assess the perception of mothers and/or care givers of danger signs in newborns and their knowledge of the WHO recognized danger. A secondary aim was to explore the socio-demographic factors of mothers that influence knowledge of the WHO recognized danger signs and the health seeking behaviors of these mothers and/or care-givers.MethodsThis was a community based descriptive and analytical study which used a multistage sampling technique to select 376 mothers and/or care-givers from four communities in 4 of the 17 Local Government Areas (LGA) of Enugu State. Logistic regression and chi-square was used in testing associations between variables.ResultsKnowledge of more than three of the nine WHO recognized danger sign was poor (0.0-30.3%). Majority of the mothers had knowledge of one (i.e. fever) WHO recognized danger sign (95.2%). Knowledge of the WHO signs was not significantly associated with maternal socio-demographic variables considered in this study. Healthcare seeking behaviour was significantly determined by knowledge of at least one WHO recognized danger sign (OR 4.6 CI 1.1-18.7, P = 0.032). Cough, diarrhea and the excessive crying were the most perceived and experienced non-WHO recognized dangers signs among respondents.ConclusionThere is urgent need to strengthen the teaching and training of expectant mothers across all maternal socio-demographic variables on these danger signs and the most appropriate measures to take when they occur.

Maternal sociodemographic factors that influence full child immunisation uptake in Nigeria

Background. With vaccine-preventable disease accounting for many <5-year deaths in most developing countries, it is imperative to determine the factors responsible for poor immunisation coverage in these countries. Objective. To identify maternal sociodemographic factors associated with child immunisation uptake in Nigeria. Methods. Data from a nationally representative sample of mothers (aged 15 - 49 years) were obtained from the 2008 Nigeria demographic and health survey. Logistic regressions were used to examine the association between maternal sociodemographic variables and child immunisation uptake. Results. The overall uptake of full immunisation based on the National Programme on Immunisation schedule was 30.6%. There was wide variation in full immunisation uptake in the different regions in Nigeria, with 51% in the South-West, 46.5% in the South-East, 39.5% in the South-South, 6.4% in the North-West, 11.8% in the North-East and 28.2% in the North-Central. Approximately 40.2% of children surveyed had never received any form of vaccination. The most common reasons given for non-vaccination of these children were lack of information about immunisation, fear of side-effects and the immunisation centres being too far away. It was noted that uptake of vaccines with multiple dosing schedules dropped with each successive dose. Decreased likelihood for full immunisation was seen in mothers <18 years old (odds ratio (OR) 0.53; confidence interval (CI) 0.34 - 0.84) and mothers residing in the northern regions. Increased likelihood for full immunisation was seen in mothers from middle and rich classes (OR 1.26, CI 1.03 - 1.66 and OR 1.69, CI 1.27 - 2.25, respectively), mothers with higher educational level (OR 3.77, CI 1.52 - 9.32), mothers with access to media (OR 1.84, CI 1.21 - 1.68), mothers resident in urban areas (OR 1.36, CI 1.22 - 1.51) and mothers who had institutional deliveries (OR 1.86, CI 1.44 - 2.40). Conclusion. Full immunisation uptake in Nigeria is poor. Cultural disparity in different regions of Nigeria may account for the wide variation in immunisation coverage observed.