Non-pregnant Adolescent Girls Research Articles

Suicidal ideation and suicide attempt among pregnant adolescent girls in Ghana: a cross-sectional study

BackgroundGlobally, suicide is the third leading cause of death among girls aged 15–19 years. However, there is a growing concern that suicide research has paid little attention to pregnant adolescent...

Understanding Behavioral Drivers of Iron and Folic Acid Supplementation and Vitamin A- and Iron-Rich Food Consumption among Women and Adolescent Girls in Niger.

This study examined drivers and barriers to iron and folic acid (IFA) supplementation and consumption of iron- and vitamin A-rich foods among women of reproductive age (WRA) and adolescent girls in Niger. This was an exploratory qualitative study using focus group discussions and semi-structured interviews. This study was conducted in the rural areas of three districts in Maradi and Zinder regions of southern Niger. The study included a purposive sample of 56 WRA (15-49 years), 34 non-pregnant adolescent girls (10-14 years), 105 family members and community leaders, 32 health workers, and 12 national and regional level stakeholders. Respondents demonstrated widespread knowledge of recommendations for IFA during pregnancy and had positive attitudes toward supplements. However, supply barriers were significant, and adherence was limited by side effects, among other constraints. Despite knowledge about and positive attitudes towards micronutrient source foods, respondents reported that limited food access was an overriding constraint to increasing consumption. WRA were seen as nutritionally vulnerable, however husbands were often not able to provide sufficient nutritious food and there was a cultural expectation that wives serve themselves food last. Adolescent girls were not seen as nutritionally vulnerable and there was little family support for their consumption of nutritious foods. Projects should work with local actors to develop multi-pronged solutions that address supply and access barriers for IFA and micronutrient-rich foods and to improve social support for nutrition.

Adherence, safety, and choice of the monthly dapivirine vaginal ring or oral emtricitabine plus tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis among African adolescent girls and young women: a randomised, open-label, crossover trial

Half of new HIV acquisitions in Africa occur in adolescent girls and young women. Pre-exposure prophylaxis (PrEP) with oral tenofovir disoproxil fumarate plus emtricitabine or the monthly dapivirine vaginal ring is efficacious but has lower adherence and effectiveness among adolescent girls and young women. We aimed to assess product adherence, safety, and choice of oral PrEP compared with the dapivirine ring among African adolescent girls and young women. MTN-034/REACH was a randomised, open-label, phase 2a crossover trial among HIV-seronegative, non-pregnant adolescent girls and young women aged 16-21 years at four clinical research sites in South Africa, Uganda, and Zimbabwe. Participants were randomly assigned (1:1) to either the dapivirine ring or daily oral PrEP (200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate) for 6 months, then switched to the other product option for 6 months, followed by a third 6-month period in which participants were given a choice of oral PrEP, the dapivirine ring, or neither. Fixed block randomisation was used, stratified by site. The primary adherence endpoint was use of each product during the randomised periods, with high use defined as tenofovir-diphosphate concentrations greater than or equal to 700 fmol/punch (associated with taking an average of four or more tablets per week in the previous month) and greater than or equal to 4 mg dapivirine released from the returned ring (continuous use for 28 days in the previous month) based on residual drug concentrations. The primary safety endpoint was grade 2 or higher adverse events during each randomised period of 24 weeks of ring and oral PrEP. This trial is registered at ClinicalTrials.gov, NCT03593655. From Feb 6, 2019 to Sept 9, 2021, 396 adolescent girls and young women were screened, 247 of whom were enrolled and randomly assigned (6 months of the ring followed by 6 months of oral PrEP n=124; 6 months of oral PrEP followed by 6 months of the ring n=123). Median age was 18 years (IQR 17-19). 54 grade 2 or higher product-related adverse events were reported during oral PrEP and five during dapivirine ring use, with no product-related serious adverse events. High adherence was observed in 753 (57%) of the 1316 oral PrEP visits and 806 (57%) of the 1407 dapivirine ring visits. Four women acquired HIV during follow-up. Adherence was moderately high and similar between oral PrEP and the dapivirine ring with favourable safety and tolerability. Oral PrEP and the dapivirine ring are effective, safe, and well tolerated HIV prevention options for adolescent girls and young women who would benefit from a choice of PrEP formulations to meet their needs and preferences. National Institutes of Health.

Determinants of Adolescent Nutrition Status and Practices in Burkina Faso Using a Pooled Secondary Analysis

ObjectivesAn increasing trend in consumption of fast food and high amounts of added sugars among adolescents has left most lower- and middle-income countries facing a double burden of malnutrition. Since behaviors around food and physical activity are established during adolescence, the aim of the study was to document and disseminate the nutrition practices and status among adolescents in Burkina Faso who represent 23.1% of the nation's population.MethodsThe study used pooled data, of 2,432 non-pregnant adolescent girls, from the Performance Monitoring and Accountability (PMA 2020) nutrition surveys conducted in Burkina Faso in 2017 and 2018. We looked at three nutritional outcomes: dietary diversity, consumption of added sugars on the previous day, and the mid-upper-arm circumference (MUAC) < 16cm (a proxy indicator for severe malnutrition among adolescents). Bivariate analysis and multivariate logistic regression were conducted.ResultsMinimum dietary diversity of 24.9%; consumption of added sugars of 36.7%; and prevalence of MUAC < 16 cm of 15.7% were observed among adolescents. Dietary diversity amongst adolescents was highest in the Centre region (43.5%) and lowest in the regional cluster of Sahel/Centre Nord/Nord (10.8%) and region remained an important predictor in multivariate analysis too. Added sugar consumption was 65% more likely for adolescents from the wealthiest households and almost three times higher for adolescents who had achieved minimum dietary diversity. MUAC < 16cm was lower among the 15–19 age group and 1.7 times more likely among adolescents who consumed an unhealthy food or drink the previous day, but half as likely among adolescents with dietary diversity.ConclusionsOur findings showed a strong association between high dietary diversity and unhealthy food intake namely added sugar consumption. This is an important consideration for policy makers as they design adolescent nutrition programs to reduce malnutrition. Given that nutrition behaviors and habits are developed by early adolescence, designing nutrition interventions for school-age children should be promoted as a public health strategy. Tailored strategies with regional targeting, particularly for urban areas, are recommended.Funding SourcesBill & Melinda Gates Foundation through Alive & Thrive, managed by FHI Solutions.

ARTICLE ON ADOLESCENT NUTRITIONAL ANEMIA WITH SPECIAL REFERENCE TO GIRLS

Nutritional anaemia is a major health problem worldwide. Adolescent girls are the most vulnerable group of the population due to different reasons. Adolescence is a stage of transition from childhood to adulthood. Adolescence is a physiological &amp; social process through which a child matures into an adult adolescent, comprised of 10-19 years old, from the largest generation of young people in our history. Nutritional anaemia is a serious health problem in Indian school children. A high prevalence of anaemia has been reported in non-pregnant adolescent girls. Adolescent girls are most vulnerable to the influences of cultural &amp; gen- der norms, which often discriminate against them. Dietary patterns and physical activity in addition to schooling &amp; countervailing social norms for early marriage influence the health and nutritional well-being of adolescents. At this age girls having menses and menarche age (10-13 years). In this age nutrients, requirements of iron further increase. This review article purposes the effect of various ayurvedic drugs on anaemia from the existing literature. Keywords: Ayurveda, nutritional anaemia, Pandu Roga, Adolescent girls.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data.

We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. Countrywide, covering rural and urban areas in Ghana. Non-pregnant adolescent girls aged 15-19 years. Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

Malnutrition, Hypertension Risk, and Correlates: An Analysis of the 2014 Ghana Demographic and Health Survey Data for 15–19 Years Adolescent Boys and Girls

The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes.

Iron Status of Burkinabé Adolescent Girls Predicts Malaria Risk in the Following Rainy Season.

High levels of storage iron may increase malaria susceptibility. This risk has not been investigated in semi-immune adolescents. We investigated whether baseline iron status of non-pregnant adolescent girls living in a high malaria transmission area in Burkina Faso affected malaria risk during the following rainy season. For this prospective study, we analysed data from an interim safety survey, conducted six months into a randomised iron supplementation trial. We used logistic regression to model the risk of P. falciparum infection prevalence by microscopy, the pre-specified interim safety outcome, in relation to iron status, nutritional indicators and menarche assessed at recruitment. The interim survey was attended by 1223 (82%) of 1486 eligible participants, 1084 (89%) of whom were <20 years at baseline and 242 (22%) were pre-menarcheal. At baseline, prevalence of low body iron stores was 10%. At follow-up, 38% of adolescents had predominantly asymptomatic malaria parasitaemias, with no difference by menarcheal status. Higher body iron stores at baseline predicted an increased malaria risk in the following rainy season (OR 1.18 (95% CI 1.05, 1.34, p = 0.007) after adjusting for bed net use, age, menarche, and body mass index. We conclude that routine iron supplementation should not be recommended without prior effective malaria control.

Iron deficiency and anemia in adolescent girls consuming predominantly plant-based diets in rural Ethiopia

Rapid physical growth and the onset of menstruation during adolescence can increase the risk of iron deficiency (ID) and related adverse effects. However, little is known about the risk of anemia and ID among adolescent girls in Ethiopia. Therefore, we aimed to determine the prevalence of ID, low iron stores, and anemia and characterize selected risk factors in Huruta, Arsi Zone, Oromia Region, Ethiopia. A cross-sectional study was conducted among non-pregnant adolescent girls (15–19 years of age; n = 257). Data on household socio-demographic characteristics, anthropometric measurements, and women’s dietary diversity score (WDDS) were collected. Hemoglobin (Hb) and serum ferritin (SF), C-reactive protein (CRP), and α−1-acid-glycoprotein (AGP) concentrations were measured. Diets were predominantly plant-based, with a low consumption of animal source foods, fruits, and dark-green leafy vegetables. Only 4% of the adolescent girls had adequate dietary diversity (WDDS ≥5), and 35% were underweight. The prevalence of anemia (Hb <11 g/dL, 8.7%) and clinical ID (SF <15 µg/L, 8.7%) was low, but 41% had marginal iron stores (SF <50 µg/L). The low prevalence of ID, despite a predominantly plant-based diet is atypical and calls for adapted strategies to address low iron stores in this and other similar settings of Ethiopia.

Iron-fortified lentils to improve iron (Fe) status among adolescent girls in Bangladesh - study protocol for a double-blind community-based randomized controlled trial

BackgroundLentils are generally considered to be a nutrient-dense food, and a good source of iron (Fe). This study aims to establish novel evidence of the effectiveness of the consumption of Fe-fortified lentils in improving the body Fe status and thus cognitive performance in non-pregnant adolescent girls in rural Bangladesh, compared to consumption of ordinary lentils.MethodsWe have designed a double-blind (both trial participants and outcome assessors), community-based, cluster-randomized controlled trial among 1260 Bangladeshi adolescent girls between the ages of 10–17 years who are non-smoking, not married, not pregnant, not breastfeeding, and generally healthy at the time of enrollment. The intervention will include three arms who will receive: (1) Fe-fortified lentils; (2) unfortified lentils; or (3) usual intake. Participants will be served a thick preparation of cooked Fe-fortified lentils (37.5 g raw lentils, approximately 200 g cooked lentils) 5 days per week for 85 feeding days (around 4 months) using a locally acceptable recipe. Lentils were fortified with Fe in the laboratory at the Department of Plant Sciences at the University of Saskatchewan in Canada. A subsample of participants (n = 360) will be randomly invited to be included in cognitive testing.DiscussionData on socio-demographic characteristics, household food security status, adolescent food habits and cognitive testing will be collected at baseline and endline (4 months). Venous blood samples will be collected at baseline, midline (2 months) and endline to measure adolescents’ Fe status. Computerized cognitive testing will include five common measures of attentional (three of attention) and mnemonic functioning (two of memory) carried out using DMDX software. The results of this study will be used to garner support for and to substantiate large-scale production and market expansion of Fe-fortified lentils, and will contribute to knowledge about how to enhance Fe status in adolescents worldwide in resource-poor settings, using staple food crops.Trial registrationClinicalTrials.gov NCT03516734. Registered on 24 May 2018.

Deworming in non-pregnant adolescent girls and adult women: a systematic review and meta-analysis

BackgroundThe impact of deworming on parasite load, nutritional status and other health outcomes of non-pregnant adolescent girls and adult women is uncertain.MethodsMEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, the WHO International Clinical Trials Registry Platform, the Cochrane Database of Systematic Reviews and Food and Technology s databases were searched until 24 September 2018. Studies were included if they were randomised controlled trials (RCTs), controlled before and after studies or interrupted time studies comparing deworming with no intervention or placebo in non-pregnant adolescent girls and women 10 to 49 years old. Outcomes of interest included parasite load, reinfection, anaemia, severe anaemia, iron deficiency, diarrhoea or all-cause morbidity. Risk of bias was assessed using the Cochrane risk of bias tool.ResultsWe included four RCTs of mass deworming involving 1086 participants, in the analyses. Mass deworming probably reduces the prevalence of roundworm infection (RR 0.29; 95% CI 0.14 to 0.62; 2 trials; 1498 participants, moderate certainty evidence), prevalence of hookworm infection (RR 0.32; 95% CI 0.18 to 0.59; 2 trials; 1498 participants, moderate certainty evidence), prevalence of whipworm infection (RR 0.77; 95% CI 0.65 to 0.91; 2 trials; 1498 participants, moderate certainty evidence) compared to the control group. Deworming may make little or no difference in prevalence of anaemia (RR 0.82; 95% CI 0.60 to 1.11, 3 studies, 683 participants, low certainty evidence) and prevalence of iron-deficiency (RR 0.89; 95% CI 0.64 to 1.23, 1 study, 186 participants, low certainty evidence) compared to control. We are uncertain whether deworming reduces the prevalence of severe anaemia compared to control as the certainty of evidence was very low. None of the included studies assessed screen and treat deworming or reported reinfection, diarrhoea or adverse events.ConclusionsMass deworming probably reduces the prevalence of soil-transmitted helminth infections but may have little or no effect on anaemia and iron-deficiency in adolescent girls and non-pregnant women in comparison to no intervention or placebo. We are uncertain about the effect on severe anaemia. These results are limited by sparse data and the moderate to very low quality of evidence available.Systematic review registrationThe protocol was registered in PROSPERO (registration number: CRD42016039557). Primary source of funding: Evidence and Programme Guidance unit, Department of Nutrition for Health and Development, World Health Organization (WHO).

Psychosocial Correlates of Marijuana Use among Pregnant and Nonpregnant Adolescent Girls.

Pregnant and nonpregnant populations in the United States report marijuana as the most commonly used illicit drug. Patterns of marijuana use and psychosocial correlates are unclear among non-treatment-seeking teenage girls. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The objective of this study was to use cross-sectional data to examine the psychosocial correlates of recent marijuana use among a sample of 646 pregnant and nonpregnant adolescent girls presenting to urban primary care clinics (mean age=15.6years, SD=1.9years; 65% African American; 8.8%pregnant). In Poisson regression analysis, frequency of marijuana use was significantly associated with greater likelihood of pregnancy (incident rate ratio [IRR], 1.30; 95% CI, 1.03-1.65), alcohol use (IRR, 1.11; 95% CI, 10.08-1.14), condomless sex (IRR, 1.95; 95% CI, 1.61-2.37), parents' drug use (IRR, 1.04; 95% CI, 1.02-1.05), and negative peer influences (IRR, 1.12; 95% CI, 1.10-1.16). Marijuana use among adolescent girls in this sample was associated with a number of risk behaviors as well as parental and peer influences. Culturally sensitive screening and intervention approaches for marijuana use among adolescent girls should address multiple individual, relationship, and community factors, to prevent unwanted pregnancy as well as to reduce marijuana use during this vulnerable time.

Time Trends in Prevalence of Anaemia in Adolescent Girls

Introduction: Anaemia in adolescent girls has been recognised as a major public health problem. The Mid-day meal programme guidelines envisage inclusion of 75 g/day of vegetables and use of iron fortified iodised salt for hot cooked meal. The National Iron Plus Initiative envisages weekly iron-folic acid (IFA) supplementation for adolescent girls; however, coverage and compliance have been reported to be low. Data from national surveys carried out in the last two decades were analysed to assess changes, if any, in Hb levels and prevalence of anaemia in adolescent girls. Material and Methods: Raw data from National Family Health Surveys (NFHS) -2, -3, and -4, District Level Household Surveys (DLHS) 2 and 4, and Annual Health Survey-related to Clinical, Anthropometric and Biochemical Components (AHS-CAB) were analysed to assess mean Hb, prevalence of anaemia and frequency distribution of Hb in adolescent girls. Comparison in these parameters was made between non-pregnant girls 10-14 years and 15-19 years of age in DLHS-2, -4 and AHS-CAB; in the 15-19 year age group comparisons were made between pregnant and non-pregnant girls in NFHS series and DLHS AHS series. Results: There were no clear and consistent changes in mean Hb, prevalence of anaemia and frequency distribution of Hb in pregnant and non-pregnant adolescent girls between NFHS-2, -3 and -4 either at national or at State level. However, there was a 0.7 and 1.3 g/dL increase in mean Hb levels in non-pregnant girls (10-19 yrs) between DLHS-2 and AHS-CAB and DLHS-4 States, respectively. The increase in mean Hb of pregnant girls (15-19 yrs) was 1.1 g/dL and 1.4g/dL in AHS-CAB and DLHS 4 States, respectively. There was significant reduction in prevalence of anaemia in both pregnant and non-pregnant girls between DLHS 2 and DLHS 4 and AHS-CAB at the aggregate level for each survey and in all States except Uttarakhand. Conclusion: There has been some improvement in Hb levels in adolescent girls in the last two decades. Improving dietary intake of vegetables and promoting use of iron fortified iodised salt in all households in the country have to be taken up so that iron intake across all age groups improves. This when combined with daily IFA supplementation for three months in a year in adolescent girls, might lead to sustained improvement in Hb.

An outline of anemia among adolescent girls in Bangladesh: findings from a cross-sectional study

BackgroundAnemia is a significant wide spread public health threat especially among the adolescent girls who are more vulnerable towards low level of hemoglobin particularly of low and middle income countries (LMICs). We investigated the prevalence of anemia among the adolescent girls (10–19 years) in Bangladesh and its socio-demographics distribution.MethodsWe collected data digitally in ODK platform from a sub-sample of a nationwide cross-sectional survey of 1314 adolescent girls in 2015. Capillary blood hemoglobin level was estimated using HemoCue®; anthropometric measurements through standardized procedure and details socio-demographic information were captured and analyzed. Malnutrition was defined as BMI-for-age Z-score below -2SD (BAZ < −2SD), measured in WHO-AnthroPlus. Univariate analysis followed by multiple logistic regression were performed to examine the association between socio-demographic variables and anemia, while controlling the effect of potential confounding variables.ResultsOverall, 51.6% girls were suffering from any form of anemia (non-pregnant-Hb < 12 g/dl; pregnant-Hb < 11 g/dl) while 46% were mildly (non-pregnant-Hb: 10–11.9 g/dl; pregnant-Hb: 10–10.9 g/dl) and 5.4% were moderately (Hb: 7–9.9 g/dl) anemic while only 0.2% were severely anemic. After controlling for relevant covariates in multiple logistic regression model, malnutrition (AOR: 1.42, 95% CI = 1.0–2.10, p-value = 0.083), non-pregnancy (AOR: 6.10, 95% CI = 2.70–13.78, p-value < 0.001), and households with bottom wealth quintile (AOR: 1.54, 95% CI = 1.03–2.30, p-value = 0.037) were identified as significant risk factors of anemia among adolescent girls of Bangladesh.ConclusionsHigher number of adolescent girls are still suffering from anemia in Bangladesh and non-pregnant adolescent girls contributed the most. Immediate, long term and sustainable public health intervention would require to combat the situation.

Mid-upper arm circumference is associated with biochemically determined nutritional status indicators among adolescent girls in Central Mozambique

Biochemically determined nutritional status measurements in low-income countries are often too expensive. Therefore, we hypothesized that some anthropometrical or functional measurements (handgrip) could reflect nutritional status measured by specific biochemical indicators. We did a population-based study from 1 urban area and 2 rural districts in Zambézia Province of Mozambique. The participants (n=386) were non-pregnant adolescent girls between 15 and 18 years of age. 96% had a normal BMI-for-age score. Weight and mid-upper arm circumference (MUAC) were highly correlated (r>0.8) with each other and with total body muscle mass, body mass index (BMI), and with waist circumference, as well as with skinfolds (r>0.6). Upper and total arm lengths were correlated (r>0.7) with height and with each other, and right and left handgrip were correlated only with each other, as were triceps and subscapular skinfolds (r>0.7). Serum albumin correlated negatively with waist circumference (P<.001) and positively with MUAC (P=.007). Stepwise regressions showed that waist circumference, MUAC, weight, and handgrip were important nutritional status indicators in the models using hemoglobin, serum albumin, ferritin, zinc, and plasma retinol concentrations as dependent variables. MUAC could be a valuable anthropometric marker of the overall nutritional status of adolescent girls in low-income countries. When nutrition transition proceeds, waist circumference together with MUAC could form tools for the prediction of worsening of nutritional status.

Toward Prediction of Thrombosis in Adolescent Girls On Estrogen Containing Contraceptives: Global Coagulation Profiles and Estrogen Gene Polymorphisms.

AbstractAbstract 2254 Background:Adolescent girls on oral contraceptive pills (OCPs) are at a higher risk for venous thromboembolism. OCP induced changes on coagulation and fibrinolytic pathways are complex with high inter-individual variability and factor assays are often non- informative. Global coagulation assays better delineate OCP induced coagulation changes and variability in such changes may be the result of differences in estrogen metabolism. Aims and Methods:Our study aims to: 1) Determine the prevalence of a hypercoagulable state after initiation of OCPs as measured by global coagulation assays and 2) Determine the contribution of variation in estrogen metabolism to this hypercoagulable state. In this ongoing prospective study, 36 healthy non-pregnant adolescent girls starting OCPs were enrolled after institutional review board approval. Samples were obtained prior to and after 3 months of initiating OCPs and were analyzed for tests such as prothrombin time (PT), activated partial thromboplastin time (APTT), clotting and anticoagulant factor assays, tissue factor initiated thromboelastography (TF-TEG), with t-PA (tissue plasminogen activator) modification for detecting fibrinolysis (tpa-TEG), thrombin generation +/−thrombomodulin (TM)(TG+/− TM) and estrone levels. All participants were genotyped for FV Leiden, F2 G20210, plasminogen activator inhibitor-1 (PAI-1) promoter polymorphism and 3 single nucleotide polymorphisms (SNPs) related to estrogen metabolism (estrogen receptor a (ESRa), UGT1A1, CYP3A5). SNP genotypes were compared based on coagulation tests, TG and TEG parameters and differences pre and on OCPs were examined.Results: Baseline:Median age of participants was 17 years (range 13–20). All were African American. Pre-OCP, the median FVIII activity was 160% (range 97–327) with normal values for other parameters. On OCPs:Routine tests:There were no significant differences in blood counts, von Willebrand factor (vWF) antigen, FVIII, vWF, protein C, S, Anti-thrombin, or PAI-1 activity on OCPs. The PT was shorter (10.5 ± 0.4 sec vs. 11 ± 0.4 sec, p= <0.001) on OCPs, and there were no differences in APTT.Thromboelastography:TF-TEG demonstrated higher maximum amplitude (67 ± 5.4 mm vs. 72 ± 7 mm, p= 0.024)) and G(10 ± 2.4 vs. 13± 4.3 dynes/cm, p=0.021) on OCPs. There were no differences in time to clot initiation or the rate of clot formation. Tpa-TEG did not reveal any differences in clot lysis at 30 and 60 minutes on OCPs (p= 0.8 and 0.4 respectively).Thrombin generation:TG using calibrated automated thrombography in corn trypsin inhibitor treated plasma demonstrated a shorter lag time [without TM: 2.3 min ± 0.4 vs. 1.8 ± 0.3min, p= 0.001, with TM: 2 ± 0.33min vs.1.7 ± 0.32 min, p=0.005], higher endogenous thrombin potential [without TM: 921± 289 nM.min vs. 1145 ± 350 nM.min, p=0.08, with TM: 659 ± 222 nM.min vs. 945 ± 368 nM.min, p=0.029], higher peak [without TM: 228 ± 53 nm vs. 291± 68 nm, p=0.012, with TM: 202 ± 58 nm vs. 268 ± 70 nm, p=0.023) and shorter time to peak(without TM: 4.7 ± 0.7 min vs. 3.7 ± 0.5 min, p= 0.001, with TM: 3.9 ± 0.4 min vs. 3.4 ± 0.4 min, p= 0.007)after being on OCPs for 3 months. Non-group O blood type and elevated FVIII at baseline did not correlate with ETP with or without TM after being on OCPs. Estrone levels did not correlate with peak thrombin generation pre-OCPs (R= 0.1, p=0.8).SNP genotyping:The ESRa (c.454–397T>C) polymorphism was present in the heterozygous state in 51% and homozygous state in 15% of the participants respectively. CT and CC genotype was associated with shorter lag time with TG-TM (2.7 ± 0.25 min vs. 1.7 ±0.14 min, p=0.026) but not with TF-TEG. The ESRa, UGT1A1 and CYP3A5 polymorphisms did not correlate with estrone levels or other coagulation parameters. As anticipated, FVL was absent in all and F2 G20210 (heterozygous) was present in one participant. Conclusions:In vitro thrombin generation and clot kinetics measured by global coagulation assays reveal a state of hypercoagulability in adolescent girls on OCPs not detected by routine coagulation testing. These differences appear to be likely caused by acquired activated protein C resistance as the addition of TM had less effect in patients on OCPs despite similar factor VIII activity. The presence of CT and CC genotype of the 454–397T>C polymorphism in the estrogen receptor-a, independent of estrone levels, correlated with hypercoagulability based on TG parameters but not TF-TEG. Disclosures:No relevant conflicts of interest to declare.

Sustainable Effect of Ayurvedic Formulations in the Treatment of Nutritional Anemia in Adolescent Students

Anemia is a serious health problem in Indian school children. High prevalence of anemia has been reported in nonpregnant adolescent girls. An investigation was initiated to study the effect of two non-iron-containing Ayurvedic preparations-Sootshekhar Rasa plus Sitopaladi Churna-in improving nutritional anemia among adolescent students. This was a single-blinded, randomized, controlled study. The study setting was Dehradun district, North India. The subjects comprised a total of 1646 boys and girls, aged 11-18 years, attending school in Dehradun district. As per World Health Organization guidelines, a total of 1322 adolescent anemic students were randomly divided into 5 groups. Students of group I (control) received starch. Group II, III, and IV students received Sootshekhar Rasa (SR) plus Sitopaladi Churna (SC) in various combinations, namely, SR 125 mg + SC 500 mg daily, SR 250 mg + SC 400 mg daily, and SR 250 mg + SC 400 mg weekly, respectively. Group V student were given iron and folic acid tablet. All the students received treatment for 90 days and were followed up for the next 180 days. The outcome measure was to evaluate the effect of Sootshekhar Rasa plus Sitopaladi Churna in improving nutritional anemia. The overall prevalence of anemia was found to be 81.3%. At baseline, the mean hemoglobin (Hb) was 97.4 +/- 13.2 g/L and ranged from 96.4 +/- 0.8 g/L to 98.3 +/- 0.8 g/L in various groups. At end of follow-up (day 270), a significant increase in Hb levels from baseline was observed in all treatment groups; however, the Hb gain (6.9 +/- 0.6 g/L) in group III and group V (3.64 +/- 0.56 g/L) differed significantly from the control group. A total of 155 students dropped out of the study due to various reasons not related to treatment. No adverse side-effect of Ayurvedic medication was noted in any student. We conclude that a daily dose of Sootshekhar Rasa (250 mg) plus Sitopaladi Churna (400 mg) can produce sustainable improvement of nutritional anemia in adolescent students.

Self-efficacy to Negotiate Partner Condom Use Among High-risk Adolescent Girls

Background Sexually active adolescent girls whose partners do not use condoms are at significant risk for sexually transmitted disease (SID). Low self-efficacy to negotiate partner condom use has been shown to be a major determinant of high-risk sexual behavior among adult women, but the factors that influence adolescent girls’ ability to engage in protected intercourse have not been fully explored. This study was undertaken to determine the association between self-efficacy to negotiate condom use and self-reported condom use. Methods 21 nonpregnant adolescent girls with cervicitis or pelvic inflammatory disease were enrolled over a 4-month period. Participants were interviewed to collect demographic infonnation, then completed a self-administered questionnaire, which included a 6-item condom use negotiation scale (Cronbach's alpha =.80), a 16-item SID prevention knowledge scale (Cronbach's alpha =.79), and questions on frequency of condom use, condom use at last sexual intercourse, and other sexual risk behaviors. Results Mean age was 17.3 years (range 14–22). 57% were black and 14% were Hispanic. Mean age at first sexual intercourse was 14.4 years; mean number of lifetime sexual partners was 6.2 (range 1–25) and 62% had I partner in the past 3 months. Over 80% reported high frequency partner condom use (“all of the time” or “most of the time”), but only 38% reported partner condom use at last intercourse. All participants whose partner used a condom at last intercourse also reported high frequency condom use. Mean knowledge score was 14.3 (± 2.4) (possible score 0–16). Knowledge score was not associated with condom use or negotiation score. Mean negotiation score was 26.1 (± 5.0) (possible score 6–30). Participants whose partner used a condom at last intercourse had higher negotiation scores than those whose partner did not (Wilcoxon Rank Sum test, p = 0.03). Participants who reported high frequency condom use had higher negotiation scores than those who reported low frequency condom use, but this difference was not significant. Conclusions High self-efficacy to negotiate condom use is associated with self-reported partner condom use at last sexual intercourse among high-risk adolescent girls. Further investigation into the influence of self-efficacy to negotiate condom use in adolescent girls is warranted and may have significant implications for development of STD risk reduction interventions.

A study on nutritional status of adolescent and adult pregnant and lactating women and growth of their infants.

Dietary intake and nutritional status were recorded in 27 non-pregnant adolescent girls, 20 pregnant adolescent girls, and 17 pregnant adult women. Deficiencies of energy and iron intake were more pronounced than of protein in all the three groups. Intakes of energy, protein, and iron were lower during lactation than in pregnancy because of stricter food taboos observed during lactation in order to ensure good health in the infant. The adolescent pregnant girls gained, on average, 2.7 kg in weight during pregnancy compared to a mean gain of 4.8 kg in adult pregnant women. The adolescent mothers also lost more weight during lactation (mean 2.9 kg) compared to adult women (mean weight loss 1.9 kg). There was no observable difference for up to 3 months after delivery in lactational performance between adoles cent and adult mothers. The mean birth weight was less in the case of the adolescent compared to the adult women. There was no difference in other anthropometric parameters. Infants of adult women had significantly better growth in weight and height after birth.