Nonpregnant Women Of Childbearing Age Research Articles

Fetal Demise due to Uterine Trauma With Massive Intraperitoneal Hemorrhage Associated With Chronic Perforation of the Inferior Vena Cava by an Infrarenal Filter: A Case Report With Call for Definitive Consensus Regarding Filter Positioning in Nonpregnant Women of Childbearing Age

Suprarenal placement of inferior vena cava (IVC) filters in women of childbearing age has been recommended largely based upon theoretic concerns for safety of the mother and fetus. However, cases of filter-related maternal and fetal injuries have not been previously reported. Instructions for use of commercially available permanent and retrievable IVC filters do not make distinctions based on age or sex. Although most IVC filters implanted in current practice are potentially retrievable, less than 50% are ever removed. We present the first report of serious maternal injury and fetal death resulting from uterine trauma related to chronic perforation of the IVC by an infrarenal filter, initially placed in a nonpregnant woman of childbearing age. A 36-year-old nonpregnant woman was treated with chronic anticoagulation therapy (AT) because of recurrent episodes of pulmonary embolism (PE). She developed a retroperitoneal hemorrhage due to warfarin toxicity, at which point, an infrarenal Trapease IVC filter was placed. Indefinite AT with low-molecular-weight heparin was later initiated. Chronic perforation of the IVC by the filter was incidentally noted 2 years later. Filter removal by percutaneous means was contraindicated, and given her asymptomatic status, operative removal was not offered. One year later, at age 39, she became pregnant. At an estimated intrauterine pregnancy age of 24 weeks, after physical activity, the patient developed sudden, extreme abdominal and back pain with associated dyspnea. A pulmonary computed tomography angiogram demonstrated no PE but showed free intraperitoneal fluid. She became hemodynamically unstable, concurrent with dramatic fall in fetal heart rate. Laparotomy and caesarean section were immediately performed, but the fetus was not salvageable. Bleeding was noted from a laceration to the dome of the uterus and was closed with chromic suture. A tear was noted in the peritoneal membrane overlying the filter, with barbs and vertical struts of the filter freely exposed. The vertical struts and barbs of the filter were removed, but due to instability, complete removal of the filter and IVC reconstruction was not deemed safe. Instead, the filter-bearing IVC was wrapped with a vascularized, transmesocolic omental flap. The patient's hospital course, 13 days, was complicated by intraperitoneal abscess (drained percutaneously) and wound infection. Complete healing was achieved at 10 weeks postoperatively. The patient is doing well at 4 months. Chronic AT with low-molecular-weight heparin has been continued, and the patient advised to avoid future pregnancies. Interaction between the gravid uterus and an infrarenally positioned IVC filter, presumed in the past to be a theoretic risk for IVC compression and thrombosis or perforation, is proven by this case to be a real risk. Although the filter in this case was a permanent type, use of an optional filter does not obviate this risk, because a large majority of optional filters are never removed. Societal consensus and device manufacturers should address this potential risk in guidelines for filter placement, positioning (preferably suprarenal), and emphasis on subsequent, planned filter retrieval when IVC filters are placed in nonpregnant women of childbearing age.

Serum soluble transferrin receptor concentrations in US preschool children and non-pregnant women of childbearing age from the National Health and Nutrition Examination Survey 2003–2010

BackgroundSerum soluble transferrin receptor (sTfR) is recommended as a sensitive and accurate measure of iron deficiency (ID) in populations when only a single indicator can be used. The lack of assay standardization and of representative data on the distribution of sTfR in at-risk populations currently limits its utility. MethodsUsing data from NHANES 2003–2010, we examined the distribution of sTfR and developed assay-specific cutoff values for defining elevated sTfR in 2 US populations groups: children aged 1–5y (n=2820) and non-pregnant women aged 15–49y (n=6575). ResultsOn average, children had higher geometric mean sTfR concentrations (4.09mg/l; 95% CI: 4.04–4.14) than non-pregnant women (3.31mg/l; 95% CI: 3.26–3.35) (p<0.001). Among children, those aged 1–2y (compared to those aged 3–5y), boys (compared to girls), and non-Hispanic black (NHB) children (compared to non-Hispanic white (NHW) and Mexican-American (MA) children) had higher sTfR concentrations. Among non-pregnant women, adolescents (15–19y) had higher sTfR concentrations than adults aged 20–34y but not compared to adults aged 35–49y; NHB women (compared to NHW and MA women) and multiparous women (compared to nulliparous women) had higher sTfR concentrations. The derived cutoff values (97.5th percentile in a defined healthy reference population) for defining elevated sTfR in the US were 6.00mg/l for children 1–5y and 5.33mg/l for non-pregnant women 15–49y. ConclusionsA different sTfR cutoff value may be needed in children and non-pregnant women to define ID.

Does obesity modify the association of supplemental folic acid with folate status among nonpregnant women of childbearing age in the United States?

Obesity is associated with an increased risk of having a pregnancy affected by a neural tube defect (NTD). It is not clear whether the amount of folic acid required by obese women to protect against NTDs is the same as that for nonobese women. We analyzed data from the National Health and Nutrition Examination Survey, representative of the noninstitutionalized civilian U.S. population, to assess whether body mass index (BMI; normal weight, overweight, and obese categories) modified the association between supplemental folic acid intake and folate status. We estimated the geometric mean concentration among nonpregnant women of childbearing age (15-44 years) during the postfortification period of: serum folate (2003-2008); red blood cell (RBC) folate (2007-2008); and plasma total homocysteine (tHcy; 2003-2006), adjusted for age, race and ethnicity, and total dietary folate expressed as dietary folate equivalents for strata of supplement use and BMI. BMI was inversely associated with serum folate among women who did not use supplements containing folic acid; no differences between women in different BMI categories were observed among supplement users. Regardless of supplement use, obese women had the highest RBC folate concentrations. There were no differences in tHcy by BMI, regardless of supplement use. These results do not support a straightforward modification of the relationship between supplemental folic acid intake and folate status by BMI. In this population, BMI may affect the body distribution of folate, as reflected by lower serum and higher RBC folate levels in obese women who do not use supplements.

Usual folic acid intakes: a modelling exercise assessing changes in the amount of folic acid in foods and supplements, National Health and Nutrition Examination Survey, 2003–2008

The USA currently fortifies enriched cereal grain products (ECGP) with folic acid at 140 μg/100 g. In addition, folic acid can be voluntarily added to ready-to-eat cereals (RTEC) up to 400 μg/serving and it is found in many dietary supplements, most often at a dose of 400 μg. We sought to model folic acid intake under various fortification and supplementation scenarios. The National Health and Nutrition Examination Survey is a population-based cross-sectional survey representative of the non-institutionalized, civilian US population. Information on folic acid intake is collected in two 24 h dietary recalls and survey questions on dietary supplement use, which allows estimation of usual total folic acid intake. We modelled five different levels of folic acid fortification in ECGP, while varying the amounts in RTEC and dietary supplements. United States. US adults (n 14 353) aged ≥19 years; non-pregnant women of childbearing age (n 4272). The percentage of adults with usual daily folic acid intake above the tolerable upper intake level of 1000 μg was influenced more by the typical amount in supplements, while the median intake was influenced more by the ECGP fortification level. By manipulating the amount in at least two sources, it was possible to shift the distribution such that more women of childbearing age consumed the recommended intake of 400 μg of folic acid without increasing the percentage of adults with intake above the tolerable upper intake level. The results varied among population subgroups. Our results suggest that combined strategies are required to meet population recommendations for folic acid intake.

Recommended Adult Immunization Schedule: United States, 2012*

Recommended Adult Immunization Schedule: United States, 2012*

Evaluation of pregnancy as a risk factor in the outcomes of influenza A (H1N1)/2009 in women of childbearing age

The aim of this study was to verify whether pregnancy was a risk factor for death in influenza A (H1N1)/2009 infection. We compared the case-fatality rates for pandemic influenza among non-pregnant women of childbearing age and pregnant women, besides investigating other factors that differentiated the groups in relation to the outcomes. The data were collected from the National Information System on Diseases of Notification (SINAN), of the Ministry of Health. The study used cases with laboratory confirmation and included 1,861 women from 10 to 49 years of age, of whom 352 were pregnant. The case-fatality rate during the 2009 pandemic was 4.5% for pregnant women and 6.4% for non-pregnant women (p = 0.197). Logistic regression did not show an association between pregnancy and death (OR = 0.7; 95%CI: 0.41-1.21). However, there were significant differences between the two groups in relation to mean age, treatment with oseltamivir, schooling, and presence of other risk factors.

Sero-prevalence of hepatitis B virus infection and its risk factors among pregnant women attending antenatal clinic at Aminu Kano teaching hospital, Kano, Nigeria

Background: Pregnant women infected with hepatitis B virus (HBV) can transmit the infection to their fetuses and newborns. Neonates who contract the HBV have about 90% risk of developing chronic HBsAg carriage (HBsAg: hepatitis B surface antigen) and chronic liver disease. Neonatal immunization interrupts this vertical and perinatal transmission. Objectives: To determine the seroprevalence of HBsAg among pregnant women attending the antenatal clinic at Aminu Kano Teaching Hospital (AKTH) and to identify potential risk factors associated with HBV infection. Materials and Methods: A case control study was conducted involving a total of 303 pregnant women attending the antenatal clinic at AKTH and 303 nonpregnant women of childbearing age. Blood sample was collected from each woman and the serum tested for the presence of HBsAg using latex rapid agglutination slide test kit (Cal-Tech Diagnostic Inc., USA) in the laboratory of the hospital. Reactive samples were stored at -20oC and further confirmed for HBsAg using enzyme-linked immunosorbent assay (ELISA) kits (Bio-Rad, France). HBsAg-positive samples were tested for hepatitis B e antigen (HBeAg) using ELISA kits (Orgenics, Israel). A pretested, structured questionnaire was used for the collection of sociodemographic data and possible risk factors. Results: The prevalence of HBsAg among pregnant women and nonpregnant women were 7.9 and 7.6%, respectively. There was no statistically significant difference in the prevalence of HBsAg in pregnant and nonpregnant women. The presence of HBeAg was statistically significant among both pregnant and nonpregnant women who tested positive for HBsAg. The risk factors associated with HBV infection were blood transfusion, ear piercing, history of an affected sibling with HBV infection, tattooing, and abortion among pregnant women. Conclusion: The prevalence of HBsAg in this study was not statistically different in pregnant and nonpregnant women. There was a high level of HBeAg infection among pregnant women who tested positive for HBsAg. History of an affected sibling with HBV infection, tattoo, and abortion were significant risk factors for HBV infection. Keywords: Africa, hepatitis B, pregnancy, risk factors

The use of hormones indicators in human saliva in diagnosing parodontitis in pregnant women.

AIMS:The purpose of this work– was to study the dynamics of biochemical parameters of human saliva and analyze the features of the chemical composition of the saliva of women with abnormal pregnancy and in periodontitis against pregnancy.MATERIALS AND METHODS:The study included four groups of women: a control group of nonpregnant women of childbearing age (10), pregnant women with physiological pregnancy (24-28 weeks) without any signs of periodontal disease (10), pregnant with a generalized periodontitis I--II degrees in remission (10), women with pathological pregnancy with no signs of periodontal inflammation (10). In each of the groups over two samples of saliva were collected, the first collection of saliva in the morning on an empty stomach. Then mouthwash 0.9% sodium chloride solution was assigned and after 30 minutes the second portion of saliva. By enzyme immunoassay in samples of saliva of control groups of nonpregnant and pregnant women, as well as women with signs of a pathological course of pregnancy, the content of estriol, testosterone, and dehydroepiandrosterone sulfate was determined.STATISTICAL ANALYSIS USED:Statistical data analysis was performed by the standard technique using Student's t-test.RESULTS:The results of biochemical analysis of saliva samples collected before rinsing the mouth with saline in groups of healthy nonpregnant and pregnant women were compared. It was established that during pregnancy the concentration of salivary estriol increases, but in pregnant women with periodontitis, the amount of this hormone in the saliva was significantly reduced. The highest content of testosterone in saliva samples, observed in healthy pregnant women, was significantly higher than nonpregnant women.In pregnant women with periodontitis concentration of testosterone in saliva is reduced, while remaining significantly higher than its level in the saliva of nonpregnant women. The highest concentration of testosterone is observed in the saliva of healthy pregnant women with periodontitis, but the smallest concentration of testosterone is found in the saliva of nonpregnant women. Also the nonpregnant group has the lowest levels of DHEA in pregnancy, and its content increases almost threefold when periodontal disease further growsCONCLUSIONS:It was established that periodontitis against pregnancy is characterized by higher levels of salivary DHEA sulfate and lower estriol, compared with a control group of pregnant women.

Study of the Bacterial Flora of the Vagina and Cervix in Women of Childbearing Age in Rural Community of Niger Delta Region, Nigeria

Background: The female lower genital is habited by various microorganisms as normal resident which help to protect the woman against various form of infections. Aims and objectives: This is to assess the bacterial microflora of vagina and cervix in women of rural community in a developing country. Subjects and Methods: A qualitative comparative study of the bacterial flora of the vagina and cervix of 220 nonpregnant women of childbearing age (18- 40 years) in Ikot Ekpene, Akwa Ibom State was undertaken. Results: The study revealed that both aerobic and microaerophilic organisms as well as the strictly anaerobic bacteria constituted the microflora of the lower genital of this group of women. Of the 220 women sampled, Lactobacilli were the most frequently isolated organism in both the cervix and vagina, occurring in 62.2% and 75.6% samples respectively. Proteus species were the least in incidence, occurring in only 4.1% and 5.3% in the vaginal and cervical specimens respectively. The following pathogenic organisms were isolated in both the vagina and cervix: Escherichia coli, Staphylococcus aureus, Candida albicans, Clostridium species and Beta-haemolytic Steptococci. In general, the same types of organisms were isolated in both the cervical and vaginal samples, although the incidence in the two sources varied. Conclusion: the organism from the cervix and vagina were essentially the same despite the anatomical and physiological differences of these structures.

Multiplex PCR-Based Reverse Line Blot Assay for Simultaneous Detection of 22 Virulence Genes in Uropathogenic Escherichia coli

Urinary tract infections (UTIs) are among the most common bacterial infections and are responsible for significant morbidity and health care costs worldwide. The main bacterial cause of uncomplicated UTI is Escherichia coli, which possesses numerous virulence factors (VFs). Many studies of the pathogenesis of E. coli UTI have centered on VF genes. Hence, the development of better molecular assays to study VF genes would facilitate these studies. We developed a highly sensitive and specific multiplex PCR-based reverse line blot (mPCR/RLB) assay to simultaneously detect 22 VF genes of uropathogenic E. coli and then used it to characterize 180 isolates from nonpregnant women of child-bearing age with cystitis and 153 fecal isolates from similar-age healthy women, in regional New South Wales, Australia. The assay accurately identified all VF genes (of the 22 under study) known to be present in 30 previously characterized control strains. The detection limits were 28 ng of DNA from E. coli isolates and 50 CFU/ml in mock-infected urine specimens containing known concentrations of E. coli. Cystitis isolates (compared to the fecal isolates) showed a significantly higher prevalence of 18 individual VF genes and contained significantly more VF genes per isolate (median number, 18.5 versus 6.5 [P = 0.001]). Discordance between paired probes for a given VF gene occurred in several clinical test isolates but no reference strains and among the test isolates was associated with fecal source (10% of VF genes versus 2% for cystitis isolates [P < 0.001]). This novel mPCR/RLB method is a potentially powerful tool for investigating the prevalence and distribution of VFs in E. coli.

Vitamin D status of pregnant and non‐pregnant women of reproductive age living in Hanoi City and the Hai Duong province of Vietnam

Vitamin D insufficiency during pregnancy has been associated with a number of adverse outcomes for both mother and child. Vitamin D insufficiency has been well described in many populations of both pregnant and non-pregnant women of childbearing age, but there is a lack of data on women living in South-East Asia. We measured plasma 25-hydroxyvitamin D in a representative sample of pregnant (n=64) and non-pregnant (n=477) women (15-49 years) living in Hanoi City (n=270) and rural Hai Duong Province (n=271) in northern Vietnam. Mean 25-hydroxyvitamin D (95% confidence interval) concentration was 81 (79, 84)nmolL(-1) . Mean 25-hydroxyvitamin D concentration differed between urban and rural (78 vs. 85nmolL(-1) ; P=0.016), farming and non-farming (89 vs. 77nmolL(-1) ; P<0.001) but not pregnant and non-pregnant or older vs. younger women. Only one woman had a 25-hydroxyvitamin D less than 25nmolL(-1) , a concentration indicative of vitamin D deficiency. Of the women, 7% and 48% of the women were vitamin D insufficient based on cut-offs for plasma 25-hydroxyvitamin D of 50 and 75nmolL(-1) , respectively. Mean plasma 25-hydroxyvitamin D concentrations of these Vietnamese women were much higher than those reported in other studies of pregnant and non-pregnant women in the region.

Women's alcohol consumption and risk for alcohol-exposed pregnancies in Russia.

Alcohol-exposed pregnancies (AEP) are the direct cause of fetal alcohol spectrum disorders (FASD). This study examines drinking patterns among pregnant and non-pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world. Cross-sectional survey. Seven public women's clinics in two locations: St Petersburg (SPB) and the Nizhny Novgorod region (NNR). A total of 648 pregnant and non-pregnant childbearing-age women. A face-to-face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition. Eighty-nine per cent of non-pregnant women reported consuming alcohol and 65% reported binge drinking in the past 3 months; 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at risk for AEP. There was a significant decline in drinking after pregnancy identification. Twenty per cent of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive. Russian women substantially reduce drinking after pregnancy recognition compared to pre-pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The pre-conception period presents a risk window and, therefore, a prevention opportunity.

Kinetics of the Antibody Response to Tetanus-Diphtheria-Acellular Pertussis Vaccine in Women of Childbearing Age and Postpartum Women

Because adolescents and adults act as a primary source of pertussis infection for infants, vaccination of mothers immediately postpartum is a potential strategy to reduce transmission (cocoon strategy). For this to be effective, high levels of antibodies must be achieved rapidly after vaccination. We sought to determine whether the antibody response to tetanus-diphtheria-acellular pertussis vaccine (Tdap) is sufficiently rapid to support the cocoon strategy. Two sequential studies were performed. The first was a nonrandomized, open study of a 5-pertussis-component Tdap vaccine (tetanus toxoid, diphtheria toxoid, pertussis toxoid [PT], filamentous hemagglutinin [FHA], fimbriae types 2 and 3 [FIM], and pertactin [PRN]) given to women of childbearing age; the second was a randomized, open study of Tdap or no vaccine in postpartum women. Serum levels of immunoglobin (Ig) G and IgA against pertussis antigens, serum levels of IgG against diphtheria and tetanus, and breast milk levels of IgA against pertussis antigens were measured at various times after vaccination. In both studies, the antibody response was relatively rapid, with serum IgG and IgA levels beginning to increase noticeably by days 5-7 and approaching peak levels by day 14. Greater than 68% and 84.4% of IgG and IgA responders, respectively, achieved ≥ 90% of their maximum titer by day 14. The diphtheria and tetanus antibody kinetics followed a similar time course. Breast milk levels of IgA against PT, FHA, and FIM were first detectable at day 7, peaked by day 10, and then slowly decreased through day 28. Antibodies against PRN showed a similar response, although the peak occurred at day 14. There were no significant antibody responses in the control group. Although the antibody response to a dose of Tdap in healthy nonpregnant women of child-bearing age and postpartum women occurs by day 14 and is suggestive of an anamnestic immune response, it may not be sufficiently rapid to protect infants in the first weeks of life.

SP3-20 Maternal iron deficiency anaemia during labour and its impact on birth outcomes in western Iran

IntroductionIron deficiency anaemia is one of the most common blood disorders across the world. According to the WHO, more than half of pregnant women and one third of non-pregnant women...

Prevalence, risk factors and virological profile of chronic hepatitis b virus infection in pregnant women in India

A large program was conducted by the Government of India to study the prevalence and profile of chronic hepatitis B virus (HBV) infection and its risk factors in pregnant women attending a tertiary care hospital in India. From September 2004 to December 2008 consecutive pregnant women attending the antenatal clinic were screened and those found positive for HBsAg were enrolled. Healthy non-pregnant women of child-bearing age, who presented for blood donation during the same period, served as controls. Women with symptoms of liver disease or those aware of their HBsAg status were excluded. Of the 20,104 pregnant women screened, 224 (1.1%) and of the 658 controls, 8 (1.2%) were HBsAg positive (P = ns). Previous blood transfusions and surgery were significant risk factors for infection with HBV. Of the women who were HBsAg positive, the ALT levels were normal in 54% of the women and HBV DNA levels were above 2,000 IU/ml in 71% of women. The median HBV DNA levels were higher in women who were HBeAg positive compared to the HBeAg negative group. The most common HBV genotype was D (84%) followed by A + D and A (8% each). In conclusion, the prevalence of HBsAg positivity among asymptomatic pregnant women in North India is 1.1% with 71% having high HBV DNA levels. These women may have a high risk of transmitting infection to their newborns.

Seroprevalence of TORCH infections in women of childbearing age in Croatia

During 2005–2009, a seroepidemiological study was carried out in Croatia to define the population susceptible to common TORCH agents among pregnant and non-pregnant women of childbearing age. The IgG seroprevalence was 29.1% forT. gondii, 94.6% for rubella, 75.3% for cytomegalovirus (CMV), 78.7% for herpes simplex virus type 1 (HSV-1), and 6.8% for HSV-2. Acute toxoplasmosis and CMV infection (positive IgM antibodies with low IgG avidity) were documented in 0.25% and 0.09% women, respectively. IgM prevalence was 1.2% for both HSV-1 and HSV-2. None of the participants showed acute rubella infection. Seropositivity to T. gondii and HSV-2 varied significantly between age groups (p = 0.001 and p = 0.036, respectively). Women residing in rural regions showed a significantly higher seroprevalence rate for T. gondii, CMV, and HSV-1 than urban women (T. gondii: 44.0% vs. 25.4%, p < 0.001; CMV: 85.0% vs. 73.1%, p = 0.018; HSV-1: 86.0% vs. 76.4%, p = 0.041).

Lactoferrin Efficacy versus Ferrous Sulfate in Curing Iron Disorders in Pregnant and Non-Pregnant Women

Iron homeostasis in pregnancy compensates for increased iron requirements and in women of child-bearing age for iron loss in menses. Oral administration of ferrous sulfate, prescribed to cure iron deficiency (ID) and ID anemia (IDA), often fails to increase hematological parameters and causes adverse effects. Recently, we demonstrated safety and efficacy of bovine lactoferrin (bLf) in pregnant women suffering from ID/IDA. Two clinical trials were conducted on pregnant and non-pregnant women of child-bearing age suffering from ID/IDA. In both trials, women received oral administration of bLf 100 mg/twice/day (Arm A), or ferrous sulfate 520 mg/day (Arm B). Hematological parameters, serum IL-6 and prohepcidin were assayed before and after therapy. Unlike ferrous sulfate, bLf increased hematological parameters (P less than 0.0001). In pregnant women, bLf decreased serum IL-6 (P less than 0.0001), and increased prohepcidin (P=0.0007). In non-pregnant women bLf did not change the low IL-6 levels while it increased prohepcidin (P less than 0.0001). Ferrous sulfate increased IL-6 (P less than 0.0001) and decreased prohepcidin (P=0.093). bLf established iron homeostasis by modulating serum IL-6 and prohepcidin synthesis, whereas ferrous sulfate increased IL-6 and failed to increase hematological parameters and prohepcidin. bLf is a more effective and safer alternative than ferrous sulfate for treating ID and IDA.

Iron, Folate, and B12 Deficiencies and their Associations with Anemia among Women of Childbearing Age in a Rural Area in Northern China

To assess the prevalence of folate, vitamin B(12), and iron deficiencies and their associations with anemia among women of childbearing age in northern China, an area with a reported high incidence of neural tube defects. Plasma folate, vitamin B(12), ferritin, and hemoglobin levels were measured among 1,671 non-pregnant women of childbearing age from Xianghe County, Hebei Province, China in June 2004. Geometric means [95 % confidence interval (CI)] of plasma concentrations were 9.3 (4.0, 21.6) nmol/L for folate, 213.1 (82.4, 550.9) pmol/L for vitamin B(12), 17.4 (1.1, 278.6) microg/L for ferritin, and 129.9 (104.6, 161.4) g/L for hemoglobin (Hb). Approximately 24 % of women had biochemical evidence of folate deficiency (<6.8 nmol/L), 21.4 % were deficient (<148 pmol/L) in vitamin B(12), 30.2 % had iron depletion (<15 microg/L), and anemia (Hb < 120 g/L) was detected among 15.4 % of women. Of the three nutrients, only iron depletion (ferritin < 15 microg/L) was independently associated with anemia (adjusted odds ratio = 6.4, 95 % CI 4.8, 8.6). Although there were substantial proportions of folate and vitamin B(12) deficiencies among women of childbearing age in northern China, iron deficiency was the most important contributor to anemia.

U.S. Provider Reported Folic Acid or Multivitamin Ordering for Non-Pregnant Women of Childbearing Age: NAMCS and NHAMCS, 2005–2006

Folic acid use started prior to pregnancy confers a decreased risk of neural tube defects, and yet 20-50% of pregnancies are unplanned. We sought to determine whether medical providers order folic acid (FA) or folic acid-containing multivitamins (MVI) for their non-pregnant female patients of childbearing age. This is a cross-sectional study using data from the CDC's National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (2005 and 2006). Among non-pregnant, female patients of childbearing age (15-44), the proportion of preventive visits during which a provider ordered FA/MVI supplements was determined and compared to pregnant patients. Next, the rates of FA/MVI orders were examined according to race/ethnicity, age, insurance status, region of the country, provider type, contraceptive care, income and education. Analyses were conducted using SAS-callable Sudaan to account for survey design and to obtain population estimates. There were 4,634 preventive visits for non-pregnant women of childbearing age, representing 32.1 million visits nationally. Of these visits, 7.2% included provider-ordered FA/MVI. Multivariable logistic regression analyses revealed that provider-ordered FA/MVI was most common for women ages 30-34, who receive Medicaid, and whose race/ethnicity was other than White, Black or Hispanic. Preventive care visits represent an important venue for counseling regarding the benefits of FA for women of childbearing age, but appear to be under-utilized in all women. Our findings suggest that annually there may be over 29 million missed opportunities to recommend folic acid to non-pregnant women seeking preventive care.

Stone Formation and Pregnancy: Pathophysiological Insights Gained From Morphoconstitutional Stone Analysis

We examined whether stone composition in pregnant women reflects peculiar pathophysiological conditions. We analyzed in detail the composition of stones from 244 pregnant women 17 to 44 years old and from 5,712 nonpregnant women in the same age range, as recorded between January 1991 and December 2007. Clinical features were also recorded. All stones were analyzed by morphological examination coupled with infrared spectroscopy. The 2 patient groups were compared by clinical and biochemical characteristics. Stone episodes in pregnant women manifested mainly in trimesters 2 and 3 (39% and 46%, respectively). Spontaneous passage was noted in 81% of pregnant vs 47% of nonpregnant women (p <0.0001). Calcium phosphate, mainly in the form of carbapatite, was the main stone component in 65.6% of pregnant vs 31.4% of nonpregnant women (p <0.0001). Octacalcium phosphate pentahydrate, a transition phase in calcium phosphate stone formation, was found in a 5-fold higher proportion in carbapatite stones in pregnant than in nonpregnant women, a finding also suggesting recent stone formation during pregnancy. The composition of stones manifesting during pregnancy clearly differs from that of stones formed in nonpregnant women of childbearing age, suggesting a different pathophysiology specific to the pregnant state. In view of the pH dependency of calcium phosphate stones factors that increase the physiological elevation in maternal urinary calcium excretion and pH are likely to have a role in the preferential formation of calcium phosphate stones during pregnancy.