Low Birth Weight Mortality Research Articles

The Correlation between Maternal Factors and Infants Lower Birth Weight

Background: Low birth weight (LBW) continues to remain a major public health problem worldwide. There are numerous factors contributing to LBW both maternal and fetal. The mortality of low birth weight can be reduced if the risk factors are detected early and managed by simple techniques. Objective: In this study our main goal is to assess the correlation between maternal factors and infants lower birth weight. Method: This research was conducted as a cross- sectional analysis at a tertiary care medical facility between January 2022 and January 2023. Where a convenience sample of 100 moms aged 11–19 who were hospitalized throughout the research period was chosen. Ultrasound and other diagnostic procedures verified the pregnancy. Results: During the study, the average age of the participants in the study group was 18.02±05 years, and only 19% of the patients visited the antenatal care facility more than four times. Among the study group, 34% of the participants had anemia, followed by 20% with premature rupture of membranes (PROM), 6% with preterm premature rupture of membranes (PPROM), 11% with mild eclampsia, 7% with severe eclampsia, 5% with gestational hypertension, and 6% with gestational diabetes. In terms of delivery methods, 40% had normal spontaneous vaginal delivery (NSVD), 28% had emergency lower segment cesarean section (LSCS), 17% had planned LSCS, and 13% underwent instrumental delivery. Regarding postpartum complications, 5% of the study group experienced postpartum hemorrhage (PPH), 2% had uterine atony, 3% had wound disruption, 1% had perineal tear, and 1% of the cases resulted in maternal death. Adverse neonatal outcomes were also observed, with 15% of the newborns having a body weight of less than 2500 grams, 11% having low APGAR scores, 12% developing neonatal jaundice, 2% experiencing intrauterine growth restriction (IUGR), 2% being stillborn, 1% having congenital anomalies, and 1% suffering from respiratory distress syndrome. ...

THE EFFECT OF THE TREATMENT OF KANGURU METHOD ON INCREASE WEIGHT IN LOW BORN WEIGHT

The incidence of low birth weight (LBW) is estimated at 15% of all births in the world with a range of 3.3% - 38% and is more common in developing countries or low socioeconomic conditions. Statistically, 90% of LBW incidence is found in developing countries and the mortality rate is 35 times higher than that of babies with birth weight of more than 2500 grams. LBW mortality rate in Indonesia is still high, around 27 per 1000 live births. LBW requires optimal care. Low Birth Weight (LBW) is the weight of a baby born less than 2,500 grams. The aim of this study was to examine the effect of kangaroo care on weight gain in low birth weight babies. This study is a literature review that attempts to explore the effect of kangaroo treatment on weight gain in low birth weight infants. Results from 5 articles show the significant results of kangaroo treatment on weight gain in low birth weight babies. It is suggested for mothers to apply the kangaroo treatment method as an effort that can be used to increase body weight at low birth weight newborns. In addition to increasing body weight, the kangaroo method can also increase oxygen saturation because an upright baby position can optimize respiratory function which is influenced by earth gravity so that it has an effect on the baby's ventilation and perfusion

Role of Maternal & Fetal Factors in Relation to Low Birth Weight

Introduction: Low birth weight (LBW) continues to remain a major public health problem worldwide. There are numerous factors contributing to LBW both maternal and fetal. The mortality of low birth weight can be reduced if the risk factors are detected early and managed by simple techniques. Objective: To identify the maternal and fetal factors associated with low birth weight. Materials and Methods: This case control study was conducted in Department of Pediatrics, Khulna Medical College& Hospital from January 2019 to June 2019. After delivery of the baby weight of the newborn was measured with digital weighing scale. Mothers of babies with birth weight <2500 gm were enrolled as cases and mothers of babies with birth weight _2500 gm were enrolled as controls. Results: Total 96 mothers were enrolled in this study and 48 mothers in each group. All the information was recorded in a pretested questionnaire. Statistical analysis was done by SPSS. Primipara mother had 3.153 times more likely to deliver LBW baby. Patients having anemia had 3.316 times more likely to deliver LBW baby. Patients having hypertension had 4.120 times more likely to deliver LBW baby. Preterm delivery had 28.927 times more likely to deliver LBW baby. Primipara, anemia, hypertension and preterm delivery were significantly associated with LBW. In multivariate analysis, preterm had 20.619 times more likely to deliver LBW. Conclusion: Primipara, anemia, hypertension and preterm delivery were significantly associated with LBW. Medicine Today 2022 Vol.34(2): 106-110

Maternal Risk Factors Related with Term Low Birth Weight

Introduction: Low birth weight (LBA) remains to be an important community health issue globally. There are many fetal and maternal factors that contribute to low birth weight. The risk factors of maternal side are socially and biologically related. Low birth weight mortality can be condensed if risk factors from maternal side are perceived primarily and treated through simple procedures. Aim: This research was held to investigate maternal risk factors related with low birth weight. Study Design: A record-based retrospective and case control study. Place and Duration: In the Obstetrics and Gynecology department of Lahore General Hospital for six-months duration from 21st June 2021 to 20th December 2021. Methods: A retrospective, document-based, case-control study was conducted. The collection of retrospective data was performed on the basis of medical records from the department of the Obstetrics and Gynecology. Afterwards the criteria of exclusion and reviewing the integrity of the records, 80 subjects in patients’ group and 80 in control group were included with gestation age of more than 37-weeks. In Microsoft Excel; the data was entered and SPSS 23.0 was applied for data analysis. The chi-square test, student's t-test and odds ratio were applied to identify associated factors result in low birth weight. Results: 80 cases and 80 control groups were examined in this study. The mothers mean age in the study group was 25.1 ± 5.2 years and 23.1 ± 4.28 years in the control group. The patients mean weight was 61.8±6.91 kg in the patient’s group and 64.48±8.60 kg in the control group. The pregnancy-related diseases were noted 37.5% in the patient’s group and 32.5% in the controls group. Conclusion: Maternal factors such as socioeconomic status, haemoglobin, weight, and number of deliveries were related significantly with LBW. Maternal ailments, such as high blood pressure and diabetes, can result in a low birth weight. Keywords: Low birth weight, Maternal factors.

Maternal minimum dietary diversity and associated factors among pregnant women, Southwest Ethiopia, 2021

BackgroundInadequate dietary diversity intake during pregnancy increases risks of intrauterine growth restriction, abortion, low birth weight, preterm birth, prenatal and infant mortality,and morbidity and has long-lasting health impacts. Dietary diversity during pregnancy promotes the health status of the mother and her fetus. This study aimed to assess the magnitude of minimum dietary diversity and associated factors among pregnant women attending antenatal care.MethodsA facility-based cross-sectional study was conducted among 274 pregnant women who attended antenatal care at Wacha primary hospital from January to February 2021. A systematic sampling method was used to select the study participants. The data were collected through face-to-face interviews using a structured and semi-structured questionnaire. Bivariate logistic regression was done to identify factors associated with maternal dietary diversity. Finally, multivariate logistic regression was done, and variables that showed P values of < 0.05 were considered statistically significant.ResultThe magnitude of minimum dietary diversity was 51% (95% CI: 44.5, 56.7). The mean (±SD) minimum dietary diversity score was 4.5 (± 1.268) with a minimum of 1 anda maximum of 8 food groups consumed out of ten food groups. Age fewer than 25 years (AOR 4.649; 95% CI; 1.404, 15.396), and the age group between 25 to 34 years (AOR 3.624; 95% CI: 1.315, 10.269), husband age group of 26 to 34 years (AOR 2.238; 95% CI; 1.028,4.873), and 35 to 44 years (AOR 3.555; 95% CI; 1.228,10.292) and nutrition awareness of women (AOR 2.182; 95% CI; 1.243, 3.829) were significantly associated with minimum dietary diversity.ConclusionThe consumption of minimum dietary diversity of the pregnant mothers was found to be low. Women aged less than 25 and age between 25 to 34 years, husband’s age between 26 to 34 and 35 to 44 years, and nutrition awareness were the factors significantly associated with minimum dietary diversity. Therefore, providing nutrition education and counseling service warranted to promote maternal dietary diversity.

Measuring the invisible: perinatal health outcomes of unregistered women giving birth in Belgium

Abstract Background Research on the perinatal health of women without legal residence remains limited. We aimed to describe the sociodemographic profiles of women who were not registered in the Belgian National Population Registry, and to analyse the associations of registration status with pregnancy outcomes. Methods We analysed data from birth and death certificates linked with the National Population Registry for all singleton births between 2010 and 2016 (n = 871 283). With logistic regression we estimated the odds ratios for the associations between three perinatal outcomes and maternal registration status, stratified by nationality and adjusted for socioeconomic status. Results Mothers not legally residing in Belgium represented 1.9% of births. Unregistered women from newer EU member states and non-European countries were socioeconomically disadvantaged. Except for women with South American nationality, all other unregistered groups had higher rates of prematurity, low birthweight, and perinatal mortality, compared to registered mothers (p &amp;lt; 0.0001). Unregistered women from Belgium and EU15 countries had higher rates of prematurity, low birthweight, and perinatal mortality, even after adjustment for socioeconomic status (p &amp;lt; 0.0001). In contrast, the excess perinatal mortality in unregistered non-European mothers was partly attributed to their precarious socioeconomic situation. Conclusions Unregistered women giving birth in Belgium are socioeconomically heterogeneous, with some living in Belgium (undocumented) and others abroad. Overall, unregistered women had increased risks of adverse perinatal outcomes, but the causal mechanisms probably differ starkly between Belgians, Europeans and non-Europeans; further research is needed to understand these accrued rates. Studying the populations “invisible” in national statistics is important to identify the groups in most need of integration and access to services. Key messages Unregistered women were a heterogenous group with increased risks of adverse perinatal outcomes. Unregistered women from non-EU countries were presumably undocumented migrants. Their accrued rates of adverse outcomes were partly, but not entirely, explained by their worse socioeconomic situation.

A study on effect of maternal anaemia on anthropometric profile and haemoglobin of newborns

Background & Objectives: Anaemia is one of the major health problems among antenatal mothers. Most of the anaemias seen in pregnancy are largely preventable and easily treatable if detected on time. According to WHO, Haemoglobin level below 11gm/dl at any time during pregnancy is considered as anaemia. If the mothers are anaemic, the foetuses are at a risk of preterm deliveries, low birth weight, morbidity and perinatal mortality due to impairment of oxygen delivery to placenta and foetus. Methods: Data was collected from inborn neonates born to Anaemic and Non-anaemic mothers, selected by purposive sampling technique, within 48 hours of birth. Collected data was analysed using software SPSS v16. Results: Among 1016 neonates studied,it was found that 23.6% of newborns born to mother’s with hemoglobin 11gm%). Length of the babies born to anaemic mothers (<11gm%) was found to be lower than the babies born to non-anaemic mothers, 68.50% as compared to 49.4 % in controls .Head circumference of babies born to anaemic mothers (<11gm%) was found to be in the lower range,45.86% as compared to 9.25% in controls. Babies born to mother’s with haemoglobin<11 gm%had cord hemoglobin in the range 14-15 gm/dl, 58.2 % as compared to 36.8 % in controls. Interpretation & Conclusion: Comparison of all anthropometric parameters born to neonates of Mothers with Anaemia and no anaemia was statistically significant. It was also found that the cord blood haemoglobin done in neonates born to anaemic mothers was lesser than in neonates born to non-anaemic mothers.

Витамин D в профилактике осложнений беременности и заболеваний у детей первого года жизни

Vitamin D status during pregnancy has an impact on fetal growth and development and plays an important role in the prevention of pregnancy complications. Fetal vitamin D supplementation is completely dependent on maternal status, which explains the high correlation between 25(OH)D concentrations in maternal and umbilical cord blood. Adequate vitamin D supplementation in pregnant women is associated with a decreased risk of preterm birth and low birth weight. Most newborns, regardless of gestational age, have insufficient vitamin D levels. Thus, the problem of Vitamin D supplementation is relevant not only for pregnant women, but also for newborns. Research studies of recent years have aimed at comparing the efficacy of Vitamin D dosing to prevent pregnancy complications. Doses higher than 4000 IU have virtually no effect on the risk of preeclampsia compared with doses of 4000 IU or less. Administration of Vitamin D in doses less than 2000 IU per day reduces the risk of low birth weight, intrauterine or neonatal mortality. Doses higher than 2000 IU have no additional benefit. Recommendations for vitamin D supplementation based on objective pharmacokinetic characteristics should be developed. Key words: pregnancy, vitamin D, doses, preterm birth, gestational diabetes, preeclampsia

Level and trend of low birth weight mortality in children under 1 year old in China, 2004-2018

Objective: To analyze the level and trend of low birth weight mortality in children under 1 year old in China from 2004 to 2018. Methods: The published Data Set of National Mortality Surveillance from 2004 to 2018 was used to analyze the low birth weight mortality rate, constituent ratio and changing trend in boys and girls, in urban area and rural area and in different regions in China. The Joinpoint regression model fitted by the weighted least square method was used to analyze the time variation trend and calculate the annual percentage change (APC), the average annual percentage change (AAPC) and their 95% confidence intervals in each time period. Results: From 2004 to 2018, the low birth weight mortality rate in children under 1 year old in China showed a decreasing trend with an AAPC of -8.0% (95%CI: -10.6% --5.4%). The differences between boys and girls, between urban area and rural area and among different regions gradually reduced. From 2004 to 2018, the constituent ratio of low birth weight mortality showed an increasing trend with an AAPC of 1.6% (95%CI: 0.1%-3.2%). The mortality rate in urban area (38.74 per 100 000) was higher than that in rural area (30.44 per 100 000). The annual average declining speed of low birth weight mortality rate in urban area (AAPC=-3.4%, 95%CI: -7.0%-0.3%) was slower than that in rural area (AAPC=-9.3%, 95%CI: -12.0% --6.6%). The low birth weight mortality rate of boys (36.25 per 100 000) was higher than that of girls (28.22 per 100 000). The low birth weight mortality constituent ratio in western region showed an increasing trend, its average annual percentage change (AAPC=3.2%, 95%CI: 1.7%-4.8%) increased faster than that of the eastern region (AAPC=-0.5%, 95%CI: -2.3%-1.4%). In urban and rural areas and different regions, the rate of low birth weight mortality in boys was higher than that in girls. Conclusions: From 2004 to 2018, the mortality rate of low birth weight in children under 1 year old showed a downward trend, and the constituent ratio showed an upward trend. Boys and children living in central and western regions should be the key population for maternal and child health care.

Maternal Risk factors, morbidity, and mortality pattern of LBW babies admitted in NICU: A Retrospective study done in Banas Medical College and Research Centre, Palanpur, Gujarat, India

Background: This study was undertaken to know about the maternal risk factors, morbidity, and mortality of low birth weight (LBW) babies admitted to NICU in a tertiary care hospital. Methods: This is a hospital-based, retrospective, descriptive study, done on LBW babies admitted to the NICU of Banas Medical College and Research Institute, Palanpur from January 2019- March 2020. Results: Out of the 1018 newborns admitted to NICU, 735 were LBW babies and 700 LBW babies were analyzed because 35 cases did not fit in inclusion criteria. The magnitude of LBW babies was 68.7 %.Out of 700 LBW babies, 530 (75.7%) had weight between 1.5kg to 2.49 kg,138 (19.7%) babies were of VLBW ( 1kg -1.5kg) and 32(4.57%) babies were of ELBW (weight &lt;1 kg).Out of 700 LBW babies, 450 (64.3%)were males and 250(35.7%) were females and 60 (8.57%) were term babies and 640 (91.42%)were preterm babies. Among the maternal risk factors most common was maternal undernutrition (30%), followed by maternal anemia in 180 cases (25.7%), inadequate ANC visits in 170 cases (24.2%), maternal age &lt;20 years in 110 cases (15.7%). Less common causes were bad obstetric history (1.14%), Twins delivery (1%), acute infections, and elderly primi (0.85%) respectively and the least common was PROM in 0.42%. Out of 700 babies, morbidity was seen in 590 LBW babies (84.28%). Conclusion: Identification of maternal risk factors and providing proper care and appropriate management to LBW can reduce neonatal morbidity and mortality

Prevalence of Congenital Malaria in Kisangani, A Stable Malaria Transmission Area in Democratic Republic of the Congo.

Background Gestational malaria is a major public health problem. It produces fetal complications such as low birth weight, perinatal mortality, and congenital malaria. The present study is aimed at determining the prevalence of congenital malaria and its neonatal complications in the city of Kisangani. Methods We conducted a cross-sectional study in Kisangani from 1 January to 30 September 2018. Our study population was composed of 1248 newborns born in our study sites, during the period of our study. Just after their birth, we performed the thick drop smear in the placental print and in umbilical blood smear. Results The prevalence of congenital malaria was 13.98%; 69.23% of newborns who contracted congenital malaria were from 18- to 34-year-old mothers, 53.85% from primiparous mothers, 92.31% from mothers who took intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine, all (100%) from mothers using the insecticide-treated mosquito nets and 7.69% from HIV-positive mothers. Low birth weight and perinatal mortality were recorded in 76.92% and 7.69% of congenital malaria cases, respectively. Intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine had no effect on congenital malaria (FE = 0.5218; OR: 0.8, 95% CI: 0.1651-3.8769) and on low birth weight (FE = 0.3675; OR: 1.2308, 95% CI: 0.0037-0.1464); however, it seemed to have protective effect against perinatal mortality (FE = 0.0001; OR: 0.0233, 95% CI: 0.0037-0.1464). Conclusion Congenital malaria remains a major problem in stable malaria transmission area like Kisangani, and it is grafted by major perinatal complications, particularly low birth weight and perinatal mortality. We recommend an extended study to clarify the relationship between the outcome of pregnancy and the intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine.

Overcoming Barriers for the Successful Implementation of a Kangaroo Mother Care Program in a Low-Middle Income Country

Currently low birth weight (LBW) mortality is a global leading cause of neonatal mortality, contributing to 60-70% of neonatal deaths. Low-middle income countries contribute the major portion of LBW globally, accounting for 18 million newborns, bearing an even higher burden because more than 50% of these newborns do not survive. Among others, one of the causes of high neonatal mortality in these countries is the weakness of the health care systems. The WHO emphasizes employing strategies that will facilitate attaining a sustainable goal. Kangaroo Mother Care (KMC) is a cost …

Incidence and Risk Factors of Low Birth Weight Among Babies Delivered at Tertiary Level Teaching Hospital in Nepal

Introduction: Low birth weight is directly related to both immediate and long term development and wellbeing of a person. There are numerous maternal and foetal factors contributing to low birth weight. The mortality and morbidity of low birth weight can be reduced if the maternal risk factors are detected early and managed by simple techniques.&#x0D; Methods: 207 low birth weight live newborn babies regardless of gestational age born in a tertiary level teaching institute from September 2015 to September 2016 were enrolled as cases and same number of normal birth weight babies (i.e. 2.5 to 4 kgs) as control. Information was obtained directly from mothers using pretested structured questionnaire and was analysed using SPSS version 20.&#x0D; Results: The incidence of low birth weight was found to be 9.8%. Mean weight of low birth weight babies was 1.98 kg and mean gestational age was 37.34 weeks. Among low birth weight babies, 47.8% were preterm and 52.2% were term. Out of 119 small for gestational age babies, the frequency of symmetrical small for gestational age was 45.3% and asymmetrical small for gestational age was 54.6%. There was significant association of low birth weight with multiple maternal factors like maternal age, education, weight, height, weight gain during pregnancy, ANC visits, parity, antepartum haemorrhage, previous abortion/low birth weight, birth spacing, tobacco/alcohol intake and haemoglobin.&#x0D; Conclusions: Prevalence of low birth weight is likely to be far higher than figure in isolated rural settings of our country. Contribution of SGA is higher than Appropriate for Gestational Age which brings us to a larger burden of long term morbidity and mortality. Various maternal factors are responsible for birth of low birth weight babies.

Prevalence of Hemoglobin Anemia among Pregnant Women in the Northeast of Iran

Introduction: Anemia is one of the major public health problems among pregnant women in the world. It causes low birth weight and maternal mortality during pregnancies. This study aimed to determine the prevalence of anemia and its associated factors among pregnant women. Methods: This cross-sectional study was conducted on 400 pregnant women in Shirvan city, Iran in 2015. For sampling, each of the three centers in this city were considered as a single cluster and the number of required participants from each center was selected proportional to the number of pregnant women covered by each center using systematic approach. Data collected from health records of families using a checklist were analyzed by descriptive statistics and appropriate statistical tests including chi- square, Fisher's exact, and McNemar's test. Results: The age mean ± SD of the pregnant women was 29.9 ± 5.3 with a range of 16-40 years. Most of pregnant women were in the age group of 18-35 (84.5%) years, had high school education (65.8%), and were housewives (87.8%). The prevalence of anemia in pregnant women in the first and third trimester were 4.75% (CI95%: 2.66%-6.84%) and 16% (CI95%: 12.40%- 19.60%), respectively. Prevalence of anemia increased in the third trimester (p&lt;0.01). Conclusion: Shirvan is one of the areas with a mild prevalence of anemia. However, iron deficiency anemia, as a nutritional disorder can be prevented. Therefore, community-based interventions should be implemented considering the identified associated factors.

Utility of time of onset of hypertension, ADMA and TAS in predicting adverse neonatal outcome in hypertensive disorders of pregnancy

Background: Limited studies have been conducted to evaluate the utility of indices for the prediction of the adverse neonatal outcomes in hypertensive disorders of pregnancy (HDP).Method: A total of 174 pregnant women with HDP (gestational hypertension, late onset preeclampsia, and early onset preeclampsia) and 49 controls were sampled during the third trimester. Preterm birth, low birth weight, fetal, and infant mortality and low Apgar scores were assessed.Results: Multivariate analysis confirmed systolic blood pressure (SBP), time of onset of hypertension (TOH), and total antioxidant status (TAS) as predictors of preterm births; TOH and diastolic blood pressure (DBP) to be predictors of low birth weight babies; TOH and asymmetric dimethyl arginine (ADMA) as predictors of fetal mortality and babies with low Apgar at 5 min. We found TOH as the single best predictor for adverse neonatal outcomes.Conclusion: This study identified TOH as an important predictor of most of the adverse neonatal outcomes.

Epidemiological analysis of complications in preterm infants

Objective To explore the epidemiological analysis of complications in premature infants. Methods From January 2017 to March 2018, 1800 premature babies in Ningbo Women and Children Hospital were selected in the study.The clinical data of pregnant women, premature infants and premature complications, and so on were investigated, and summarized epidemiology of premature infant complications. Results The probability of premature birth was 9.09%.The differences between different gestational age(χ2=2 481.34) and different body weight(χ2=3 088.21) were statistically significant(all P 0.05). However, compared with other factors, the difference of premature infants at different gestational weeks was statistically significant(P<0.05). Conclusion Epidemiological study of preterm infants, can promote their perinatal management level and quality, and then pointed to strengthen perinatal health education and health care, for the effective prevention and treatment of common diseases of perinatal, key management and monitoring work earnestly strengthen the high-risk pregnancy, attaches great importance to the establishment of collaborative relationship between made in pediatric claims intrauterine transhipment, making pregnant women can be produced in the hospital for treatment for premature babies, and reduce the mortality and morbidity rates of premature and low birth weight, can reduce the risk of intellectual disability, eventually making the birth population overall quality improved. Key words: Premature babies; Complications; Epidemiology; Among medical; Premature rupture of membranes; Mental disabilites

Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study

BackgroundGrowing evidence indicates that the risk of obstetric and perinatal outcomes is higher in women with assisted reproductive technology (ART). However, there is little known about pregnancy related complications and co-morbidity in gestational diabetes mellitus (GDM) following singleton pregnancies achieved by ART in comparison with spontaneous conception (SC).MethodsTwo hundred sixty singleton pregnant women conceived by ART and 314 pregnant women conceived by spontaneous conception (SC) were participated in this prospective cohort study. All participants were enrolled after GDM screening through one-step oral glucose tolerance test (OGTT) and then grouped into GDM and non-GDM groups. Women were followed for pregnancy outcomes including pregnancy-induced hypertension (PIH), preeclampsia, antepartum hemorrhage (APH), cesarean section (CS), preterm birth (PTB), intrauterine growth restriction (IUGR), being small or large for gestational age (SGA or LGA), macrosomia, low birth weight (LBW), respiratory distress, neonatal hypoglycemia, NICU admission and perinatal mortality from antenatal visits to delivery. Confounding factors were adjusted in logistic regression model in order to estimate adjusted odds ratios (aORs).ResultsAmong 260 ART and 314 SC, 135 and 152 women were GDM women, respectively. Higher maternal age and pre-gravid BMI, shorter duration of gestation and lower gestational weight gain were observed in GDM groups (ART-GDM and SC-GDM) compared to those of the SC group. ART-GDM group had a higher risk (95% confidence interval) of obstetric complications including PIH [aOR:7.04 (2.24–22.15)], preeclampsia [aOR:7.78 (1.62–37.47)], APH [aOR:3.46 (1.28–9.33)], emergency CS [aOR:2.64 (1.43–4.88)], and perinatal outcomes such as PTB [aOR:3.89 (1.51–10.10)], LBW [aOR:3.11 (1.04–9.30)] and NICU admission [aOR:4.36 (1.82–10.45)], as well as neonatal hypoglycemia [aOR: 4.91 (1.50–16.07)], compared to SC group. SC-GDM group showed a higher risk of PIH [aOR: 4.12 (1.31–12.89)], emergency CS [aOR: 2.01 (1.09–3.73] and LGA [aOR: 5.20 (1.07–25.20)], compared to SC group. Additionally, ART group had a higher risk of PIH [aOR: 3.46(1.02–11.68), preeclampsia 5.29 (1.03–27.09), and NICU admission [aOR: 2.53 (1.05–6.09)] compared to SC. Insulin requirement (41.8% vs. 25.7%) was significantly higher in ART-GDM group compared to SC-GDM group.ConclusionThe findings of this study suggest that GDM occurring after ART conception increases the risk of adverse obstetric and perinatal outcomes.

A Cost-Effectiveness Model for Comparing Multiple Micronutrient Supplements to Iron and Folic Acid Supplements During Pregnancy: Applications in Pakistan, Bangladesh, and India

Background - Recent evidence has encouraged low- and middle- income countries to consider transitioning from long-standing iron and folic acid supplementation (IFAS) to multiple micronutrient supplementation (MMS) during pregnancy. However, global guidance is limited. To help countries' decision-making, a cost-effectiveness model to compare the supplementation modalities was developed, and applied to: Pakistan, Bangladesh, and India. Methods - The effectiveness of IFAS relative to MMS during pregnancy was compared using eight health outcomes reported in the literature: maternal anaemia, preterm delivery, small-for-gestational-age newborns, low birth weight, stillbirths, and maternal, neonatal, and infant mortality. Outcomes were aggregated using disability-adjusted life years (DALYs) to derive an overall effectiveness of IFAS and MMS. Costs included the supplements and their distribution through antenatal care. The incremental cost-effective ratio (ICER) for transitioning from IFAS to MMS was calculated for each country, and Monte Carlo simulations were applied to generate a measure of certainty around the results. Findings - In Pakistan, Bangladesh, and India, MMS would avert 11,749, 12,462 and 9,332 more DALYs than IFAS per 100,000 pregnancies, respectively (80.0%, 91.0%, 87.0% certainty). The ICER of transitioning from IFAS to MMS was 15.53, 13.94, and 19.55 USD (2016) per DALY averted, respectively. Interpretation - As per World Health Organization criteria, transitioning from IFAS to MMS is cost-effective. While the effectiveness of MMS is sensitive to the prevalence of various health outcomes, with high confidence 80.0%-91.0% MMS averts more DALYs than IFAS and should re-enter public health discussion in Pakistan, Bangladesh, and India. Funding Information: Nutrition International with a grant from Global Affairs Canada and World Vision Canada. Competing Interest Declaration: All authors declare they have no conflicts of interest.

An Association Between Anemia and Postpartum Depression [35C

INTRODUCTION: Anemia in pregnancy has been associated with increased rates of low birth weight, preterm delivery, and perinatal mortality in several previous studies. Despite these complications, few have investigated the impact of anemia on postpartum women. This postpartum period can be extremely difficult for mothers as 19% of United States women experience postpartum depression (PPD). It is therefore imperative to investigate anemia as a possible physiologic risk factor for PPD. METHODS: This retrospective cohort study was conducted by collecting hematocrit and demographic data from medical records of patients meeting all criteria. Patients included were women ≥16 years old who received postpartum care at Women’s Ambulatory Health Services in Hartford, Connecticut from January 2014 to January 2017. Those excluded were patients &lt;16 years old, those on psychiatric medications, those with disease disrupting iron metabolism, tobacco users, patients receiving blood transfusions, or those experiencing neonatal mortality. Records were categorized into anemic and non-anemic. Percentage of Edinburgh Postnatal Depression Scale (EPDS) ≥11 vs &lt;11 were compared using Chi square test. RESULTS: 922 women fulfilled study requirements and completed the EPDS questionnaire. 9.2% of study patients screened positively for PPD (EPDS ≥11). 75.2% were anemic antenatally or immediately postpartum. The difference in PPD incidence for those anemic (10.8%) vs non-anemic (4.8%) was statistically different (P=.007). Anemic patients had an increased risk of screening positive for PPD (RR 2.25, 95% CI 1.22-4.16). CONCLUSION: Anemia during pregnancy or peripartum is associated with an increased incidence of PPD and thus should be further investigated as a potential risk factor for PPD.

Child Bearing Age and Pregnancy Outcomes in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey

Background: Delayed childbirth has increased significantly over the past several decades in developed countries while teenage pregnancy is still common in developing countries. Assessing the association between adolescent childbearing and the risk of perinatal and health outcomes may help policy makers to reform or formulate new policies to prevent premature death, disability and other adverse perinatal outcomes. Objectives: To assess the association between adolescent pregnancy and the risk of adverse maternal, obstetrical and neonatal outcomes. Study design: Data was extracted from 2011 Bangladesh Demographic and Health Survey (BDHS). This is a nationally representative population-based survey with a two-stage stratified cluster sample design. Outcomes for adolescent women ≤ 19 years of age were compared with those of women aged 20 to 34 years (young adult) and ≥ 35 years (adult). Multilevel Poisson regression models were used to determine the associated adverse birth and health outcome with maternal age. Results: The mean age at childbearing was 26 years. Prevalence of adverse perinatal outcomes including low birth weight, stillbirths, stunting and perinatal mortality were substantially higher among adolescent mothers compared to the young adults. Multilevel regression models indicated that higher risk of low birth weight (adjusted relative risk (aRR), 1.15; 95% CI, 1.00-1.33), childhood stunting (aRR, 1.06; 95% CI, 0.98-1.14) and early neonatal mortality (aRR, 1.60; 95% CI, 0.85-1.27) were observed among the adolescent mothers compared to young adult mothers. Maternal age 35 years or over found to be a greater risk factor for pregnancy termination (aRR, 1.31; 95% CI, 1.09-1.56), caesarean delivery (aRR, 1.35; 95% CI, 1.02-1.79) and menstrual irregularities (aRR, 1.35; 95% CI, 1.02-1.79) than for young adult mothers. Conclusion: Pregnant women aged ≤ 19 years and ≥ 35 years are at increased risk of different adverse birth and health outcomes. Social awareness needs to be increased about the consequences of early and late childbearing to prevent premature death and disability and adverse perinatal outcomes.