Number Of Adverse Pregnancy Outcomes Research Articles

IMPACT OF COVID-19 ON PREGNANCY (REVIEW)

SARS-CoV-2 infection during pregnancy is associated with a number of adverse pregnancy outcomes, including preeclampsia, preterm birth, and stillbirth, especially among pregnant women with severe COVID-19. Several fetal complications such as early pregnancy loss, delivery of a premature fetus, preeclampsia, fetal death, vertical transmission, intrauterine growth retardation, and congenital structural anomalies in association with COVID-19 disease have been investigated.Тo review on the fetal adverse outcome that is likely to occur during COVID-19 disease. The fetal detrimental outcomes that have been widely studied in the literature include preterm birth, stillbirth, vertical transmission. The evidence in the literature supports that there is a higher rate of preterm birth and stillbirth in women who tested positive for SARS-CoV-2 but their association with the disease is not completely clear. Furthermore, the emergence of other possible outcomes is not conclusively stated. Hence more studies are required to establish their association with COVID-19 disease to decrease and mitigate the risk of detrimental fetal outcomes through early interventions and preventive measures

Integrated single-cell RNA-seq and DNA methylation reveal the effects of air pollution in patients with recurrent spontaneous abortion

BackgroundMaternal air pollutants exposure is associated with a number of adverse pregnancy outcomes, including recurrent spontaneous abortion (RSA). However, the underlying mechanisms are still unknown. The present study aimed to understand the mechanism of RSA and its relationship with air pollution exposure. We compared data of decidual tissue from individuals with induced abortions and those with RSA by bulk RNA sequencing (RNA-seq), reduced representation bisulfite sequencing (RRBS), and single-cell RNA sequencing (scRNA-seq). Differentially expressed genes (DEGs) were verified using RT-qPCR and pyrosequencing. A logistic regression model was used to investigate the association between air pollutants exposure and RSA.ResultsWe identified 98 DEGs with aberrant methylation by overlapping the RRBS and RNA-seq data. Nineteen immune cell subsets were identified. Compared with normal controls, NK cells and macrophages accounted for different proportions in the decidua of patients with RSA. We observed that the methylation and expression of IGF2BP1 were different between patients with RSA and controls. Furthermore, we observed significant positive associations between maternal air pollutants exposure during the year prior to pregnancy and in early pregnancy and the risk of RSA. Mediation analyses suggested that 24.5% of the effects of air pollution on the risk of RSA were mediated through IGF2BP1 methylation.ConclusionThese findings reveal a comprehensive cellular and molecular mechanism of RSA and suggest that air pollution might cause pregnancy loss by affecting the methylation level of the IGF2BP1 promoter.

Preconception care utilization and associated factors among reproductive age women in Mizan-Aman town, Bench Sheko zone, Southwest Ethiopia, 2020. A content analysis.

BackgroundPreconception care is highly important in reducing a number of adverse pregnancy outcomes and helps to improve maternal health. Preconception care optimizes women’s health and improves pregnancy outcomes. It is a cost-effective first-line preventive strategy for birth defects. However, preconception care utilization in Ethiopia was very low. Studies on these issues are limited in Ethiopia in general and in Mizan-Aman town in particular.ObjectiveTo assess preconception care utilization and associated factors among reproductive age women in Mizan-Aman town, Bench-Sheko Zone, Southwest Ethiopia.MethodsA community based cross-sectional study design was employed from April 16 to May 26, 2020 in Mizan-Aman town. The total study participants were 624 reproductive age women. Data were collected by using pre-tested interviewer administered questionnaires and entered into Epi-data version 3.1 then exported to STATA version 14 and analyzed accordingly. Univeriate and Bivariable analysis was done by analysis of variance (ANOVA) and independent t-test. Multivariable statistical analysis using generalized linear regression model (GLM) approach was used to classify factors of preconception care utilization. Since our response variable is measured in terms of count variable, we used a Poisson regression model with a log link function. Finally, Statistical significance between dependent and independent variables were assessed by odds ratios and 95% confidence intervals.ResultsOverall, 28.6% of the women receipt atleast one item of preconception care while only 1.5% were taken the whole recommended components of preconception care services. The most common item received in the study area was taking micronutrient supplementation (18.5%). Age of women, educational status, husbands educational status, husbands occupation, wealth status, distance from the health facility, waiting time to get services, planning to pregnancy, age at first pregnancy, previous ANC use, Previous PNC use, adverse pregnancy experience, women’s knowledge of preconception care, and attitude on preconception care were determinants of preconception service utilization.ConclusionsPreconception care component utilization was lower as compare with recommended service with different disparities. Multipurpose tailored strategies which incorporate a woman with no formal education, poor knwledge on preconception care,never take maternal services previously and distant from health facility could improve preconception care service utilization. Advocative strategies on preconception care component and planning pregnancy may elicite more women to use the services of preconception care.

Maternal pre-pregnancy body mass index and pregnancy outcome

The mother's nutritional status both before and during pregnancy is an important factor that influences the evolution of pregnancy and the condition of the fetus and the newborn. Maternal weight, either through excess or deficit, is associated with a number of adverse pregnancy outcomes that can affect both mother and fetus. Knowing the maternal body mass index (BMI) and how it can influence the outcome of pregnancy is an important step in preconception care, and prompt nutritional intervention can prevent possible complications.

Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes.

Autoimmune conditions are associated with an increased risk of adverse pregnancy complications and outcomes, suggesting that pregnancy complications may mediate the excess risk. We performed a causal mediation analysis to quantify the mediated effects of autoimmune conditions on adverse pregnancy outcomes. We queried a California birth cohort created from linked birth certificates and hospital discharge summaries. From 2,963,888 births, we identified women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis, and inflammatory bowel disease (IBD). Pregnancy complications included preeclampsia/hypertension, gestational diabetes mellitus, and infection in pregnancy. Adverse pregnancy outcomes were preterm birth, cesarean delivery, and small for gestational age. We performed a mediation analysis to estimate the total effects of each autoimmune condition and adverse pregnancy outcome and the indirect effects through pregnancy complications. All 4 autoimmune conditions were associated with preterm birth and cesarean delivery, and RA, SLE, and IBD were associated with offspring that were small for gestational age. The strongest mediator of RA, SLE, and psoriasis was preeclampsia/hypertension, accounting for 20-33% of the excess risk of preterm births and 10-19% of excess cesarean deliveries. Gestational diabetes mellitus and infections generally mediated <10% of excess adverse pregnancy outcomes. Of the 4 autoimmune conditions, selected pregnancy complications mediated the least number of adverse pregnancy outcomes among women with IBD. We found evidence that some excess risk of adverse pregnancy outcomes is mediated through pregnancy complications, particularly preeclampsia/hypertension. Quantifying excess risk and associated pathways provides insight into the underlying etiologies of adverse pregnancy outcomes and can inform intervention strategies.

Periodontal Medicine: 100 Years of Progress

Periodontal medicine is a term used to describe how periodontal infection/inflammation may impact extraoral health. Periodontitis has been linked to over 50 systemic diseases and conditions. As part of the Journal of Dental Research’s Centennial Celebration, this narrative review discusses periodontal medicine research done over the past 100 y, with particular focus on the effects of periodontal disease on 3 pathological conditions: cardiovascular disease, diabetes mellitus, and adverse pregnancy outcomes. We selected 29 total studies that were the “first” of their kind, as they provided novel observations or contributed to shifting paradigms as well as important studies that made strong contributions to progress in understanding relationships to the systemic conditions. These studies were organized in an overview timeline and broken down into timelines by topic: cardiovascular disease (n = 10), diabetes (n = 12), and adverse pregnancy outcomes (n = 7). Overall, the majority of cross-sectional, case-control, and longitudinal studies have revealed positive associations between poor periodontal status and cardiovascular disease, diabetes metabolic control, and a number of adverse pregnancy outcomes, and these associations are upheld in systematic reviews. Findings from randomized controlled trials testing the effects of periodontal therapy on systemic health outcomes were conflicting and inconsistent. While there has been a great deal of progress, we highlight lessons learned and make comments and suggestions on a number of key aspects, including the heterogeneity of case definitions of periodontal disease across studies, accounting for features of the periodontal phenotype that are most relevant to the biological link between periodontitis and systemic outcomes, the role of other comorbid inflammatory conditions, selection of study participants, and timing and intensity of the periodontal intervention.

Risk for Cesarean section in women of advanced maternal age under the changed reproductive policy in China: A cohort study in a tertiary hospital in southwestern China.

To describe changed epidemiological features of advanced maternal age (AMA) and to examine the effect of AMA on the risk for Cesarean section (CS) in a Chinese pregnant population. This retrospective single-center cohort study investigated the changes of epidemiological features of AMA parturients with respect to the revised reproductive policy in China in 43 702 singleton deliveries with live birth at ≥28 weeks managed from January 2005 to December 2016. We also evaluated the pregnancy outcomes in different age groups and risk factors of CS with multivariate analysis. In this 12-year study period, the average maternal age increased from 28.5 to 30.2 years, and the proportion of AMA raised from 6.5% to 17.2%. AMA was significantly associated with increased risk of adverse pregnancy outcomes, and after adjustment for confounding factors, AMA remained a significant independent risk factor for CS. Furthermore, the effect of AMA in nulliparous women on the risk of CS was more significant than in multiparous women, while the history of previous CS (adjusted odds ratio 39.85) and interdelivery interval ≥10 years (adjusted odds ratio 1.52) also increased the risk of CS in multiparous women. AMA increased the risk of a number of adverse pregnancy outcomes, and was independently associated with increased risk for CS. The increasing number of AMA parturients with risk factors is likely to increase CS rate in China in the near future, thus it is imperative to reduce the rate of primary CS as a matter of policy.

РАСПРОСТРАНЕННОСТЬ ЭКСТРАГЕНИТАЛЬНЫХ ФАКТОРОВ РИСКА И ИХ ВЛИЯНИЕ НА НЕБЛАГОПРИЯТНЫЕ ИСХОДЫ БЕРЕМЕННОСТИ

Цель. Изучение распространенности экстрагенитальных факторов и их влияния на риск развития неблагоприятных исходов беременности в Красноярском крае.Материалы и методы. Для изучения факторов риска неблагоприятных исходов беременности использованы данные перинатального мониторинга Красноярского края, который функционирует на базе Красноярского краевого медицинского информационно-аналитического центра. В анализ включены данные о 122 250 случаях беременности в период с 2014 по 2017 гг. Все анализируемые случаи беременности распределены на 2 группы: I группа – случаи беременности с неблагоприятными исходами (8 290 случаев), II группа – случаи беременности с благоприятными исходами (113 960 случаев). В работе проанализированы следующие факторы: наличие сахарного диабета, артериальной гипертензии и гипотензивного синдрома, хронической специфической инфекции, заболеваний почек, варикозной болезни, тромбозов и тромбофлебитов, заболеваний щитовидной железы и надпочечников, пороков сердца без нарушения кровоснабжения, травм и переломов, нарушений мозгового кровообращения и миопии у матери.Результаты. Результаты проведенного исследования свидетельствуют о том, что большинство факторов оказывают влияния на риск развития неблагоприятных исходов беременности. В наибольшей степени на данный риск оказывают влияние наличие положительной реакции на волчаночный антикоагулянт, сахарного диабета, артериальной гипертензии II и III степени тяжести у матери.Заключение. Использование информации о распространенности и влиянии экстрагенитальных факторов на риск развития неблагоприятных исходов беременности позволит наиболее эффективно осуществлять маршрутизацию беременных по уровням оказания медицинской помощи для снижения числа неблагоприятный исходов беременности. Полученные результаты свидетельствуют о том, что на риск развития неблагоприятных исходов беременности оказывает влияние довольно широкий спектр факторов. При этом каждый фактор оказывает различное по степени влияние на данный риск.

Placental location and pregnancy outcomes in nulliparous women: A population-based cohort study.

The impact of placenta previa on pregnancy, delivery and infant outcomes has been extensively studied. However, less is known about the possible association of placental location other than previa with pregnancy outcomes. The aim of this study was to investigate if placental location other than previa is associated with adverse pregnancy, delivery and infant outcomes. This is a population-based cohort study, with data from the regional population-based Stockholm-Gotland Obstetric Cohort, Sweden, from 2008 to 2014. The study population included 74087 nulliparous women with singleton pregnancies resulting in live-born infants, with information about placental location from the second-trimester ultrasound screening. The association between placental location (fundal, lateral, anterior or posterior) and pregnancy outcomes was estimated using logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated, and adjustments were made for maternal age, height, country of birth, smoking in early pregnancy, sex of the infant and in vitro fertilization. Main outcome measures were pregnancy, delivery and infant outcomes. Compared with posterior placental location, fundal and lateral placental locations were associated with a number of adverse pregnancy outcomes, the most important being: very preterm birth (<32weeks of gestation) (adjusted OR [aOR] 1.78, 95% CI 1.18-2.63 and aOR 2.12, 95% CI 1.39-2.25, respectively), moderate preterm birth (32-36weeks of gestation) (aOR 1.23, 95% CI 1.001-1.51 and aOR 1.62, 95% CI 1.32-2.00, respectively), small-for-gestational-age birth (aOR 1.67, 95% CI 1.34-2.07 and aOR 1.77, 95% CI 1.39-2.25, respectively) and manual removal of the placenta in vaginal births (aOR 3.27, 95% CI 2.68-3.99 and aOR 3.27, 95% CI 2.60-4.10, respectively). Additionally, lateral placental location was associated with preeclampsia (aOR 1.30, 95% CI 1.03-1.65) and severe postpartum hemorrhage (aOR 1.42, 95% CI 1.27-1.82). Compared with posterior placental location, fundal and lateral placental locations are associated with a number of adverse pregnancy, delivery and infant outcomes.

Prediction of Adverse Pregnancy Outcomes among Women with Type 1 Diabetes

Women with type 1 diabetes are at a greater risk for adverse pregnancy outcomes (APO) compared with the general population, though factors relating to the occurrence of APO have not been well studied. We thus assessed predictors of APO among women with type 1 diabetes. Female participants (n=325; mean baseline age 28, duration 19 years) of a prospective cohort of childhood onset type 1 diabetes were selected for study. Among 320 with pregnancy data available, all pregnancies occurred after study entry (1986-88) for 61 (mean baseline age 21 and duration 14 years). APO were defined as tubal/ectopic pregnancies, spontaneous or induced abortions and stillbirths. Follow-up time was calculated as time in years from study entry to the date of the first adverse pregnancy outcome or date of last live birth for those with normal pregnancies. During 25 years of follow-up, 28 (45.9%) had at least one APO. With the exception of a greater number of total pregnancies in those with an APO (p=0.03), no other univariate differences were observed. In multivariable Cox models, a greater number of pregnancies (HR=1.49, p=0.03), log albumin excretion rate (HR=1.27, p=0.03) and proliferative retinopathy (HR=5.04, p=0.003) predicted APO. In multiple linear regression analyses, the number of pregnancies (β=0.58, p&amp;lt;0.0001) and the presence of proliferative retinopathy (β=0.75, p=0.01) directly predicted number of APO. In analyses excluding induced abortions from the outcome definition (19 adverse events (31.1%)), glomerular filtration rate was the only predictor of any APO (HR=0.98, p=0.08). A greater number of pregnancies (β=0.48, p&amp;lt;0.0001), non-HDL cholesterol (β=0.006, p=0.04), white blood cell count (β=-0.10, p=0.05) and proliferative retinopathy (β=0.74, p=0.02) predicted number of APO. Among women with type 1 diabetes, the presence of microvascular complications relates to both the occurrence and the number of subsequent adverse pregnancy outcomes. Disclosure T. Costacou: None. D. Rubinstein: None. T.J. Orchard: None.

Is there a role for placental senescence in the genesis of obstetric complications and fetal growth restriction?

The placenta ages as pregnancy advances, yet its continued function is required for a successful pregnancy outcome. Placental aging is a physiological phenomenon; however, there are some placentas that show signs of aging earlier than others. Premature placental senescence and aging are implicated in a number of adverse pregnancy outcomes, including fetal growth restriction, preeclampsia, spontaneous preterm birth, and intrauterine fetal death. Here we discuss cellular senescence, a state of terminal proliferation arrest, and how senescence is regulated. We also explore the role of physiological placental senescence and how aberrant placental senescence alters placental function, contributing to the pathophysiology of fetal growth restriction, preeclampsia, spontaneous preterm labor/birth, and unexplained fetal death.

36 Risk factors and outcomes of preeclampsia in twin pregnancies

Introduction Pre-eclampsia (PE) is associated with significant maternal and perinatal mortality and morbidity. Twin pregnancy is at greater risk than singleton for developing PE. It is, however, unclear which risk factors are most strongly associated with the development of PE in a twin gestation. Objectives To establish the risk factors for PE in twin pregnancies and investigate the perinatal outcomes in these complicated pregnancies. Methods This was a cohort study of twin pregnancies cared for at St George’s University Hospital (SGH), London. Maternal, foetal and neonatal data were obtained from the hospital’s computerised database and maternity records. The diagnosis of PE was made following the ISSHP diagnostic criteria. Maternal risk factors were assessed at booking. Pregnancies complicated by aneuploidy, major structural abnormalities, miscarriage and those ending in termination were excluded from the analysis. The statistical analysis was performed using Mann–Whitney U and Chi-square tests for the comparison between the pregnancies that developed PE and those that did not. Logistic regression analyses were performed to identify and adjust for potential confounders. Results A total of 1250 twin pregnancies (2500 fetuses) were included in the analysis [284 (22.72%) were monochorionic and 966 (77.28%) dichorionic]. Of these, 120 (9.6%) were complicated by PE. While univariable analysis found that nulliparity (OR = 0.1.69, 95%CI = 1.13–2.52, p = 0.010), maternal age ⩾40 years (OR = 0.47, 95%CI = 0.27–0.81, p = 0.006), body mass index (BMI) (OR = 1.05, 95%CI = 1.02–1.09, p = 0.004) and chronic hypertension (OR = 3.02, 95%CI = 1.45–6.30, p = 0.003) were significant risk factors for the development of PE, multivariable logistic regression analysis found that only BMI (aOR = 1.06, 95%CI = 1.02–1.10, p = 0.002), chronic hypertension (aOR = 3.13, 95%CI = 1.44–6.79, p = 0.004), and nulliparity (aOR = 1.85, 95%CI = 1.19–2.89, p = 0.007) were independent risk factors for PE in a twin gestation. Chorionicity was not associated with the risk of developing PE (p = 0.772) compared to normotensive twin pregnancies. Those complicated by PE were more likely to have a number of adverse pregnancy outcomes, including induction of labour (66% vs 47.9%, p = 0.017), emergency Caesarean delivery (38.3% vs 19.4%, p  Conclusions Nulliparity, increased maternal BMI and chronic hypertension were risk factors for PE in twin pregnancies, while monochorionicity, ethnicity and assisted reproductive techniques were not. In common with singleton pregnancies, twin pregnancies complicated by PE are at greater risk of an adverse pregnancy outcome. Prediction models for PE in twin pregnancies are likely to include risk factors that differ from those used in singleton pregnancy models.

Cost-effectiveness of HIV and syphilis antenatal screening: a modelling study

ObjectivesThe WHO called for the elimination of maternal-to-child transmission (MTCT) of HIV and syphilis, a harmonised approach for the improvement of health outcomes for mothers and children. Testing early in...

Vitamin D Status Affects Serum Metabolomic Profiles in Pregnant Adolescents.

Vitamin D is linked to a number of adverse pregnancy outcomes through largely unknown mechanisms. This study was conducted to examine the role of vitamin D status in metabolomic profiles in a group of 30 pregnant, African American adolescents (17.1 ± 1.1 years) at midgestation (26.8 ± 2.8 weeks), in 15 adolescents with 25-hydroxy vitamin D (25(OH)D) ≥20 ng/mL, and in 15 teens with 25(OH)D <20 ng/mL. Serum metabolomic profiles were examined using gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry. A novel hierarchical mixture model was used to evaluate differences in metabolite profiles between low and high groups. A total of 326 compounds were identified and included in subsequent statistical analyses. Eleven metabolites had significantly different means between the 2 vitamin D groups, after correcting for multiple hypothesis testing: pyridoxate, bilirubin, xylose, and cholate were higher, and leukotrienes, 1,2-propanediol, azelate, undecanedioate, sebacate, inflammation associated complement component 3 peptide (HWESASXX), and piperine were lower in serum from adolescents with 25(OH)D ≥20 ng/mL. Lower maternal vitamin D status at midgestation impacted serum metabolic profiles in pregnant adolescents.

Poor knowledge about gestational weight gain limits provision of counselling by maternity care providers: A systematic review

Abstract of a presentation that was present at the NSA 2014 Annual Scientific Meeting, 26-28 November, Hobart, Australia. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Gorman, E., Billington, T., Lucas, C., Probst, Y. & Charlton, K. E. (2014). Poor knowledge about gestational weight gain limits provision of counselling by maternity care providers: a systematic review. Abstracts of HSA 2014 Annual Scientific Meeting (pp. 1-1). Australia: HSA. This conference paper is available at Research Online: http://ro.uow.edu.au/smhpapers/2351 POOR KNOWLEDGE ABOUT GESTATIONAL WEIGHT GAIN LIMITS PROVISION OF COUNSELLING BY MATERNITY CARE PROVIDERS: A SYSTEMATIC REVIEW E Gorman, T Billing, CJ Lucas, Y Probst, KE Charlton School of Medicine, University of Wollongong NSW Contact e-mail: eg336@uowmail.edu.au Background/Aims: Excessive gestational weight gain (GWG) is associated with a number of adverse pregnancy outcomes. Women receiving appropriate weight gain advice from their maternity care provider are more likely to gain weight within recommended ranges. Evidence suggests that relatively few women receive appropriate counselling. This study aimed to explore factors that influence whether information on appropriate GWG is provided to pregnant women by midwives and other maternity care providers. Methods: A systematic literature review using Scopus, Web of Science and Medline databases (2004-2014) was conducted in May 2014. Peer-reviewed English language studies from western countries exploring maternity care providers’ knowledge of and practices related to GWG were included. Results: Twenty one studies were included. Maternity care providers believed GWG to be an important obstetric issue but lacked knowledge regarding correct body mass index classification and appropriate GWG targets. Inadequate knowledge of GWG was cited as a frequent barrier to the provision of counselling. Providers with a high self-perceived knowledge of GWG were more likely to include this topic in their counselling of pregnant women. To improve GWG knowledge maternity care providers expressed a desire for further training and education. Interactive problem based learning was cited as a favourable model for future education. Conclusions: Maternity care providers may refrain from offering, or provide incorrect, GWG advice, due to an inadequate understanding of the topic. Further understanding of this relationship and other barriers that may prevent provision of weight gain counselling is needed. Funding source(s): N/A

The importance of taste on dietary choice, behaviour and intake in a group of university students

s / Journal of Nutrition & Intermediary Metabolism 1 (2014) 1e55 37 showed a difference in salt content per serving between SR and HR (2.2 ± 2.1 g vs. 1.4 ± 1.2 g; p 1⁄4 0.010). Conclusions: Standard CC recipes or CC recipes targeting healthy eating and weight loss do not differ; and do not meet healthy eating benchmark guidelines. Funding source(s): N/A. THE IMPORTANCE OF TASTE ON DIETARY CHOICE, BEHAVIOUR AND INTAKE IN A GROUP OF UNIVERSITY STUDENTS S. Kourouniotis , R.S.J. Keast , S. Cicerale . 1 School of Exercise and Nutrition Sciences, Deakin University, VIC, Australia E-mail: sara.cicerale@deakin.edu.au (S. Kourouniotis) Background/Aims: Overweight and obesity prevalence is on the rise within Australia and evidence suggests that excess energy intake is a major contributor to this excess weight gain. Foods high in energy-density contribute to excess energy intake, as they tend to be more palatable and have been associated with increased food consumption. The ‘taste of food’ has been considered an important factor influencing food choice in previous international research. Methods: Participants were recruited from Deakin University, Melbourne. A food frequency questionnaire and a Food and Diet questionnaire were used to assess intake frequency of food consumption over the prior month and to assess dietary behaviours such as how important taste was on food choice within the student population. Results: The study included 1,306 participants (mean ± SD BMI 22.3 ± 3.2, age 20.5 ± 4.5 years, female 1⁄4 1,026, 84% Australian). Taste was rated the most important factor influencing food choice (82%), followed by quality (81%), cost (47.6%) and ease of preparation (37%). Correlation analysis revealed weak, negative correlations between taste importance and BMI (n 1⁄4 1,205, r 1⁄4 -0.003, p < 0.05), weak positive correlations between taste importance and gender (n 1⁄4 1281, r 1⁄4 0.127, p < 0.01); eating 5 serves of vegetables daily (n1⁄4 1290, r1⁄4 0.005, p < 0.01); eating 2 serves of fruit daily (n 1⁄4 1291, r 1⁄4 0.011, p < 0.01); consumption of convenience meals (n 1⁄4 1290, r 1⁄4 0.015, p < 0.05) and takeaway (n 1⁄4 1290, r 1⁄4 0.058, p < 0.05). Conclusions: Taste was considered an important factor in food choice, however only weak associations between taste importance and demographics, BMI, dietary behaviours and dietary intake were found. This suggests that other factors may play a stronger role in food consumption within the student population. Funding source(s): N/A. POOR KNOWLEDGE ABOUT GESTATIONAL WEIGHT GAIN LIMITS PROVISION OF COUNSELLING BY MATERNITY CARE PROVIDERS: A SYSTEMATIC REVIEW E. Gorman , T. Billing , C.J. Lucas , Y. Probst , K.E. Charlton . 1 School of Medicine, University of Wollongong NSW, Australia E-mail: eg336@uowmail.edu.au (E. Gorman) Background/Aims: Excessive gestational weight gain (GWG) is associated with a number of adverse pregnancy outcomes. Women receiving appropriate weight gain advice from their maternity care provider are more likely to gainweight within recommended ranges. Evidence suggests that relatively few women receive appropriate counselling. This study aimed to explore factors that influence whether information on appropriate GWG is provided to pregnant women by midwives and other maternity care providers. Methods: A systematic literature review using Scopus, Web of Science and Medline databases (2004-2014) was conducted in May 2014. Peerreviewed English language studies from western countries exploring maternity care providers’ knowledge of and practices related to GWGwere included. Results: Twenty one studies were included. Maternity care providers believed GWG to be an important obstetric issue but lacked knowledge regarding correct body mass index classification and appropriate GWG targets. Inadequate knowledge of GWG was cited as a frequent barrier to the provision of counselling. Providers with a high self-perceived knowledge of GWG were more likely to include this topic in their counselling of pregnant women. To improve GWG knowledge maternity care providers expressed a desire for further training and education. Interactive problem based learning was cited as a favourable model for future education. Conclusions: Maternity care providers may refrain from offering, or provide incorrect, GWG advice, due to an inadequate understanding of the topic. Further understanding of this relationship and other barriers that may prevent provision of weight gain counselling is needed. Funding source(s): N/A. MAKING HEALTHY FOOD CHOICES: A QUALITATIVE INVESTIGATION TO UNDERPIN THE E-ASSESSMENT OF NUTRITION LITERACY J.A. Gifford , A.M. Cassar , H.T. O’Connor , G.S. Denyer . 1 Faculty of Health Sciences, University of Sydney, Australia; 2 Faculty of Science, University of Sydney, Australia; Charles Perkins Centre, University of

A Cross-Sectional Study of Anemia and Body Mass Index in Student's Attending a Women's College in Bagalkot, North Karnataka

Body mass index in pre-pregnancy has been suggested as useful criteria for the assessment of risk of low birth weight in their offspring. Iron deficiency anemia is a major factor contributing to maternal morbidity and mortality. A significant fall in birth weight has been reported to occur with maternal Hemoglobin levels below 8-G%. It has been claimed that the damage to fetal brain arising from maternal anemia takes place early in pregnancy. In view of these considerations, this cross sectional study was conducted to know the anthropometric measurements, body mass index and iron deficiency anemia in students attending a women's college in Bagalkot city. Ethical clearance was obtained from Institutional ethical committee. Anthropometry is an important element in assessing the nutritional status of the subject. Each student's weight in Kilogram and height in centimeters was measured and body mass index (BMI) calculated using the formula- weight in Kg/height in m2. Hemoglobin was assessed by Acid Hematin method. After Informed consent from the participants, data was obtained and recorded on a pre-designed questionnaire and analyzed by percentages. Majority of the students (51.12%) were from rural areas of Bagalkot Taluka. Most of the students (54.50%) had mild anemia. When body mass index was calculated, majority of the students (52.47%) were underweight. Women with low pre-pregnancy body mass index are at increased risk for a number of adverse pregnancy outcomes including preterm birth and IUGR.

[Clinical management of disorders hemostasis-related with obstetric complications].

The aim of the study was the reduction of adverse pregnancy outcomes in women with gestational and genetically determined changes in the hemostatic system. The study group comprised 98 patients with obstetric complications on the background of changes in the parameters of coagulation screening. In 63 pregnant women, hemostatic disorders were not corrected, in 35 patients medical tactic defined clinical situation and the results of laboratory and instrumental studies of the hemostatic system. Hereditary thrombophilia detected in 85% of patients with obstetric complications. Carriage of the rare allele of MTHFR-677 2-fold increased risk of adverse pregnancy outcomes; heterozygous carriers of polymorphism PAI-1 - 1.5 times more. The prognostic parameters thrombelastographic (sensitivity 80%, specificity 82%) were higher than in laboratory tests. To determine the most predictive of adverse pregnancy outcome has a density of fibrin clot--the maximum amplitude. In women with obstetric complications associated with disturbances in the hemostatic system, medical diagnostic tactics using c thrombelastographic evaluates all stages of coagulation and fibrinolysis, allows you to select a reasonable pathogenetic anticoagulant therapy and reduce the number of adverse pregnancy outcomes.

Association between vitamin D insufficiency and adverse pregnancy outcome: global comparisons

BackgroundVitamin D insufficiency has been associated with a number of adverse pregnancy outcomes, and has been recognized as a public health concern.AimThe objective of this study was to determine the impact of vitamin D deficiency on maternal complications like gestational diabetes mellitus (GDM), anemia, iron deficiency, and preeclampsia among pregnant women.Subjects and methodsThis was a cohort study undertaken at antenatal clinics at the Women’s Hospital of Hamad Medical Corporation in Doha. A total of 2,487 Arab pregnant women above 24 weeks’ gestation with any maternal complication were approached, and 1,873 women (75.3%) consented to participate in the study. Data on sociodemographic and clinical characteristics by interview and biochemistry parameters were retrieved from medical records. Multivariate logistic regression analysis was performed to determine the associated risk factors.ResultsOf the studied pregnant women, nearly half of them had vitamin D deficiency (48.4%). Younger women below 30 years old (43.2%, P = 0.032), housewives (65.3%, P = 0.008), and those on low monthly household incomes (QR5,000–9,999) (49.2%, P = 0.03) were significantly more likely to have lower vitamin D compared with those who had sufficient vitamin D levels. Exposure to sunlight (63.4%, P = 0.05), daily physical activity (64.4%, P = 0.05), and vitamin D supplement intake (89.7%, P < 0.001) were significantly lower in deficient pregnant women. In the study sample of pregnant women, 13.9% had GDM, 11.5% had anemia, 8.6% had iron deficiency, and 6.9% had preeclampsia. Severe vitamin D deficiency was significantly higher in pregnant women with GDM (16.5% vs 11%), anemia (17.1% vs 11%), iron deficiency (18.5% vs 11.2%), and preeclampsia (19.8% vs 11.4%) when compared to the uncomplicated group. Socioeconomic status was low in pregnant women with complications like GDM, anemia, iron deficiency, and pre-eclampsia. Pregnancy complications like GDM (52.7%), anemia (53.2%), iron deficiency (55.6%), and preeclampsia (51.9%) were higher in Qataris. Also, GDM (66.2%), anemia (66.2%), iron deficiency (68.5%), and preeclampsia (58.1%) were observed more commonly among housewives compared to working women. Obesity was significantly more common in pregnant women with GDM (41.5%) and preeclampsia (41.1%).ConclusionThe study findings revealed that maternal vitamin D deficiency in pregnancy is significantly associated with elevated risk for GDM, anemia, and preeclampsia. The risk of vitamin D deficiency was higher in Qataris, housewives and those with low monthly household income.

Global Push: Multicontinent Project Assesses Particulate Matter and Birth Weight

Maternal exposure to ambient air pollution has been associated with a number of adverse pregnancy outcomes including low birth weight, defined as a full-term infant weighing less than 2,500 g (about 5 lb, 8 oz) at birth. But it’s been difficult to translate these findings into health-protective policies because of inconsistencies across studies—something the International Collaboration on Air Pollution and Pregnancy Outcomes (ICAPPO) is working to remedy. This worldwide, multicenter project used a common analysis protocol to derive combined effect estimates of maternal exposure to coarse and fine particulate matter (PM10 and PM2.5, respectively) and to assess differences in how the centers conducted their individual studies [EHP 121(3):367–373; Dadvand et al.]. ICAPPO researchers at 14 centers in 9 countries generated effect estimates for ambient PM10 and PM2.5 in relation to more than 3 million live, singleton, term births. For this analysis, the authors used a meta-analysis approach to synthesize contributing factors such as study setting, availability of air pollutant data, birth data, and maternal socioeconomic status. They estimated combined effects across centers and used meta-regression analysis to determine how each center’s particular characteristics and exposure assessment methods influenced differences in effect estimates among centers. All these factors can contribute to variation in results across studies. Higher maternal exposure to PM10 and PM2.5 was associated with lower birth weight across the study population. The investigators found a positive association between low birth weight and increased PM10 and PM2.5 exposure during the entire pregnancy, as well as a negative association between increased PM10 exposure and term birth weight when all averages were compared. Analysis of more than 3 million births worldwide yielded strong evidence of a link between low birth weight and prenatal exposure to particulate matter air pollution. Differences in average PM2.5 exposure levels and PM2.5/PM10 ratios influenced effect estimate outcomes—centers with higher PM2.5 levels and higher PM2.5/PM10 ratios reported stronger associations with birth weight. These findings could indicate a geographical variation in the association between air pollution and low birth weight. Meta-regression analyses also showed that centers reported stronger associations if they conducted a temporal exposure assessment only (i.e., exposure was determined according to the time period that each woman was pregnant) compared with those that accounted for both spatial and temporal elements of exposure (i.e., exposure was determined by time of pregnancy and where the woman lived). Although the study does not include direct measurements of personal exposure levels, it does provide a comprehensive estimate of the global effects of maternal exposure to particulate matter on birth weight. This could prove useful for shaping meaningful public health policies regarding air pollution.