Preterm Neonatal Death Research Articles

Predictors of effective kangaroo mother care, exclusive breastfeeding, and skin-to-skin contact among low birthweight newborns in Amhara, Ethiopia.

Globally, 20% of all newborns are born with low birth weight (LBW). There is, therefore, an urgent need to expedite the delivery of high-impact, evidenced-based, and low-cost interventions such as kangaroo mother care (KMC (defined as continuous skin-to-skin care) and exclusive breastfeeding for this vulnerable group. A multinational World Health Organization (WHO)-supported consortium created and tested the impact of locally-specific and globally-informed phases of KMC care on KMC uptake/scale-up across multiple sites. Here we report on the study of KMC predictors that is nested within Amhara's KMC implementation trial in Amhara, Ethiopia. We used multivariate logistic regression phases to identify diverse predictors of KMC, skin-to-skin contact, and exclusive breastfeeding at hospital discharge and day 28 of life. We analysed data from 860 LBW newborns. At day 28, implementation period (adjusted odds ratio (aOR) = 3.2-5.0), hospital facility (aOR = 3.0-4.6), and having multiple births (aOR = 0.31) were the strongest predictors of effective KMC. Meanwhile, previous death of a newborn, type of health facility where delivery occurred, and previous LBW delivery were predictors of effective KMC at both time points. No single factor predicted KMC, skin-to-skin contact, and exclusive breastfeeding at all time points and across all implementation periods. Having multiple births was a negative predictor for skin-to-skin contact, while the implementation period and having older fathers (>29 years) were strong positive predictors for exclusive breastfeeding at both discharge and day 28. Mothers with a previous history of neonatal death and current skin-to-skin-care uptake strongly predicted exclusive breastfeeding uptake at both time points. At discharge, however, having a history of preterm birth and neonatal death strongly predicted exclusive breastfeeding uptake, while multiple current births, current very LBW newborns, and the use of standard binders decreased the likelihood of exclusive breastfeeding. To achieve the effective KMC coverage target of ≥80% in Ethiopia, KMC scale-up phases may have to consider the key predictors of KMC, EBF, and SSC to effectively target beneficiaries.

Study of Different Breastfeeding Parameters by Using Breastfeeding Assessment Tools in Urban Tertiary Care Hospital

Background: In India, only 56% of mothers breastfeed exclusively for the first six months, as recommended. Given India’s extraordinarily high rates of preterm births, infant mortality, neonatal deaths and maternal fatalities, exclusive breastfeeding becomes even more crucial. There are many advantages of breastfeeding, but there are lots of barriers that need to be addressed. These problems need a proper objective assessment. Aims: To assess optimum positioning and attachment in mother-infant dyads, infant breastfeeding behaviour in the early neonatal period and early breastfeeding skills in mothers. Methods: A prospective cross-sectional study was conducted in the postnatal ward of a tertiary care hospital. In total, 208 full-term neonates (Age - 24 hours to 7 days) who were admitted to a postnatal ward of a tertiary care hospital and who were on direct breastfeeding were observed for breastfeeding. Objective assessment of breastfeeding was done by using the Bristol Breastfeeding Assessment Tool, Infant Breast-Feeding Assessment tool and LATCH tool. Statistical analysis was done by using SPSS version 25 with appropriate statistical tests. Result: For the BBAT tool, 110 (52.9%) infants were well supported while feeding and 118 (56.7%) had proper latching or attachment. For IBFAT Score Analysis, 109 (52.4%) infants were effective vigorous feeders and 95 (45.7%) and 4 (1.9%) were moderately effective feeders and poor feeders, respectively. For LATCH Score Analysis, 173 (83.2%) mother-infant dyads achieved a high score and 35 (16.8%) achieved moderate score. Conclusion: Objective assessment of breastfeeding by using these tools will help to identify the problem related to breastfeeding for both baby and mother. Addressing a particular problem in a timely manner will help the mother and the baby to establish, initiate and sustain exclusive breastfeeding. Caesarean-delivered mothers as well as primiparous mothers both needed more focused counselling for breastfeeding positioning, motivation for early initiation breastfeeding, a strong supportive relationship, adequate assistance during the early neonatal period for breastfeeding and proper guidance to sustain exclusive breastfeeding.

Predictors of Preterm Neonatal Mortality in India and Pakistan: A Secondary Analysis of Data from PURPOSe Study.

Objective. To create a prediction model for preterm neonatal mortality. Methods. A secondary analysis was conducted using data from a prospective cohort study, the Project to Understand and Research Preterm Pregnancy Outcome South Asia. The Cox proportional hazard model was used and adjusted hazard ratios (AHR) with 95% confidence intervals (95% CI) were reported. Results. Overall, 3446 preterm neonates were included. The mean age of preterm neonates was 0.65 (1.25) hours and 52% were female. The preterm neonatal mortality rate was 23.3%. The maternal factors predicting preterm neonatal death was any antepartum hemorrhage, AHR 1.99 (1.60-2.47), while neonatal predictors were preterm who received positive pressure ventilation AHR 1.30 (1.08-1.57), temperature <35.5°C AHR 1.18 (1.00-1.39), and congenital malformations AHR 3.31 (2.64-4.16). Conclusion. This study identified key maternal and neonatal predictors of preterm neonatal mortality, emphasizing the need for targeted interventions and collaborative public health efforts to address disparities and regional variations.

Incidence and Predictors of Mortality Among Preterm Neonates Admitted to Jimma University Medical Center, Southwest Ethiopia: a Retrospective Follow-Up Study.

This study aimed to assess incidence and predictors of mortality among preterm neonates in Jimma University Medical Center, Southwest Ethiopia. A retrospective follow-up study was conducted among 505 preterm neonates admitted to the Neonatal Intensive Care Unit of Jimma University Medical Center from 01 January 2017, to 30 December 2019. Data were collected from medical records using a data collection checklist. Data were entered into Epi-Data 3.1 and analyzed with STATA 15. Cox-regression analysis was fitted to identify predictors of preterm neonatal mortality. Variables with p-value <0.05 were declared a statistical significance. The cumulative incidence of preterm neonatal death was 25.1%. The neonatal mortality rate was 28.9 deaths (95%CI: 24.33, 34.46) per 1,000 neonate-days. Obstetric complications, respiratory distress syndrome, neonatal sepsis, perinatal asphyxia, antenatal steroid exposure, gestational age at birth, and receiving kangaroo-mother care were predictors of preterm neonatal mortality. Preterm neonatal mortality rate was high. Hence, early detection and management of obstetric and neonatal complications, use of antenatal steroids, and kangaroo-mother care should be strengthened to increase preterm neonatal survival.

Effect of prenatal passive tobacco smoke exposure on full-term birth weight of born neonates:SR

Abstract Prenatal smoking increases the risks of pre-term birth, stillbirth, neonatal death, and perinatal death as well as neurodevelopmental disorders in children. However, there is a lack of consistency in research published about association/impacts of passive smoking and low birth weight (LBW). Hence, we carried out this systematic review to determine whether or not there is a relation between prenatal tobacco smoke exposure and full-term LBW infants. Following PRISMA guidelines, we carried out systematic searches with PubMed, CINAHL, PsycInfo, and Embase for cohort case-control studies the 31-year period from 1991 - 2022. Of the 2,877 articles identified, 835 duplicates were removed. Title screening was done for 2,126 articles. 25 articles met the inclusion criteria that were Peer reviewed full-text articles in the English language and related to LBW due to passive smoking only. We found 20/25 articles showed a significant relationship with an OR ranging between 2.14 and 54.9 respectively between exposure to environmental tobacco smoke (ETS) and LBW infants at term and 5 articles showed no association with an OR ranging between 0.48 and 1.51. A significant difference found between the sample size among the studies included influencing the outcome of the study (ranging from smallest (n = 208) and largest (n = 17412). Mean age of mother was 29.6±3.8 and mean birth weight was 3,212±467.1. Nicotine level &amp;gt; 4.1 ng/mL or duration of exposure 24.4 hours/week gives strong evidence of prevalence of LBW among SHS exposed mothers. Compiled evidence suggests that, there is a significant association between prenatal passive smoke exposure and neonatal birth-weight at full term. There is a need for health researchers and public health experts to design and implement targeted programmes to reduce LBW due to passive smoke in our societies. Key messages • Exposure to ETS from domestic sources has a substantial influence on birth weight. • Combining educational programmes and legislative interventions is required to eliminate infants’ contact with tobacco smoke in utero and throughout childhood.

Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study.

Although the survival of preterm neonates has improved, thanks to advanced and specialized neonatal intensive care, it remains the main reason for neonatal admission, death, and risk of lifelong complication. In this study, we assessed time to death and its predictors among preterm neonates admitted to neonatal intensive care units (NICU) at public hospitals in southern Ethiopia. A hospital based retrospective cohort was conducted among preterm neonates admitted to NICU at public hospitals in west Guji and Borena zones, Oromia National Regional State, southern Ethiopia. Simple random sampling technique was used to select records of preterm neonates admitted to both major hospitals in the study area. Data on neonatal condition, obstetric information, and status at discharge were collected from admission to discharge by trained research assistant through review of their medical records. Kaplan Meir curve and Log rank test were used to estimate the survival time and compare survival curves between variables. Cox-Proportional Hazards model was used to identify significant predictors of time to death at p<0.05. Of 510 neonates enrolled, 130(25.5%; 95% CI: 22-29) neonates died at discharge or 28days. The median survival time was 18 days with an interquartile range of (IQR = 6, 24). The overall incidence of neonatal mortality was 47.7 (95% CI: 40.2-56.7) per 1000 neonatal days. In the multivariable cox-proportional hazard analysis, lack of antenatal care (AHR: 7.1; 95%CI: 4-12.65), primipara (AHR: 2.3; 95% CI: 1.16-4.43), pregnancy complications (AHR: 3.4; 95% CI: 1.94-6.0), resuscitation at birth (AHR: 2.1, 95% CI: 0.28-0.77) and not receiving Kangaroo mother care (AHR: 9.3, 95% CI: 4.36-19.9) were predictors of preterm neonatal death. Despite admission to NICU for advanced care and follow up, mortality of preterm neonates was found to be high in the study settings. Addressing major intrapartum complications is required to improve survival of neonates admitted to NICU.

Placental inflammation and pregnancy outcomes: A prospective, observational study in South Asia: The PURPOSe study.

To examine inflammatory lesions in placentas of stillbirths, preterm neonatal deaths and term controls in India and Pakistan. Prospective, observational study. Three hospitals in India and a large maternity hospital in Pakistan. The enrolled participants with placentas available for histology evaluation included stillbirths (n = 814), preterm live births who died within 28 days of birth (n = 618) and term live birth controls (n = 201). From this same population, polymerase chain reaction (PCR) analysis for pathogens was performed on 809 stillbirth placentas, 614 neonatal death placentas and the placentas of 201 term controls. Placentas from preterm infants who lived beyond day 28 (n = 1432) were only available from India. A prospective observational study of placental inflammatory lesions defined by the Amsterdam criteria and on the same placentas, multiplex PCR evaluation for 75 pathogens using TaqMan Array Cards. Any placental inflammatory lesions, including chorioamnionitis, funisitis, villitis and intervillitis and their association with various pathogens. In the Indian liveborn preterm infants, placental inflammation of any kind was present in 26.2% of those who died versus 16.6% of those who lived (p = 0.0002). Chorioamnionitis was present in 25.8% of those who died versus 16.3% of those who lived (p = 0.0002) and funisitis was present in 4.1% of those who died versus 1.5% of those who lived, (p = 0.005). Across all three sites, in the placentas of the 201 term controls, 18.9% had any inflammation, 16.9% had chorioamnionitis, 5.5% had funisitis, 0.5% had intervillitis and none had villitis. Overall, for stillbirths, any inflammation was observed in 30.2%, chorioamnionitis in 26.9%, funisitis in 5.7%, intervillitis in 6.0% and villitis in 2.2%. For the neonatal deaths, any inflammation was present in 24.9%, chorioamnionitis in 23.3%, funisitis in 8.1%, intervillitis in 1.9% and villitis in 0.5%. Compared with the placentas of term controls, in neonatal deaths, only chorioamnionitis was significantly increased (23.3% versus 16.9%, p = 0.05). Among stillbirths, the rates of any inflammation, chorioamnionitis, intervillitis and villitis were similar across the birthweight groups. However, funisitis was more common in the placentas of stillborn fetuses weighing 2500 g or more (13.8%) compared with 1.0% for those weighing less than 1000 g and 4.8% for stillborn fetuses weighing 1000-2499 g. In the PCR studies, Ureaplasma spp. were by far the most common pathogens found and generally were more commonly found in association with inflammatory lesions. Chorioamnionitis was the most common type of placental inflammatory lesion regardless of whether the placentas evaluated were from term controls, stillbirths or neonatal deaths. For stillbirths, inflammation in each inflammation category was more common than in the term controls and significantly more so for any inflammation, chorioamnionitis, intervillitis and villitis. For neonatal deaths, compared with the placentas of term controls, all inflammation categories were more common, but only significantly so for chorioamnionitis. Ureaplasma spp. were the most common organisms found in the placentas and were significantly associated with inflammation.

The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review.

The PURPOSe study was a prospective, observational study conducted in India and Pakistan to determine the cause of death for stillbirths and preterm neonatal deaths, using clinical data together with minimally invasive tissue sampling (MITS) and the histologic and polymerase chain reaction (PCR) evaluation of fetal/neonatal tissues and the placenta. After evaluating all available data, an independent panel chose a maternal, a placental and a fetal/neonatal cause of death. Here, we summarise the major results. Among the most important findings were that most stillbirths were caused by fetal asphyxia, often preceded by placental malperfusion, and clinically associated with pre-eclampsia, placental abruption and a small-for-gestational-age fetus. The preterm neonatal deaths were primarily caused by birth asphyxia, followed by various infections. An important finding was that many of the preterm neonatal deaths were caused by a nosocomial infection acquired after neonatal intensive care (NICU) admission; the most common organisms were Acinetobacter baumannii, followed by Klebsiella pneumoniae, Escherichia coli/Shigella and Haemophilus influenzae. Group B streptococcus was less commonly present in the placentas or internal organs of the neonatal deaths.

Morphological study of the placenta in deliveries with pre-eclampsia: Results from a prospective, observational study in India and Pakistan (PURPOSe).

To compare placental findings in women with and without pre-eclampsia. The PURPOSe study included women with stillbirths, women with preterm births and women at term as controls. The placenta of each case was evaluated using the Amsterdam criteria. Two sites and five tertiary care hospitals of south Asia (Three in India and two in Pakistan). Pregnancies in India and Pakistan with placental histology including women with documented hypertension and documented proteinuria and women with neither hypertension nor proteinuria. We compared the placental findings of the two groups using the Amsterdam criteria and further evaluated the placental findings in women with and without pre-eclampsia who had a stillbirth, preterm live birth, or term live birth (control). The main outcome measures were the frequency of maternal and fetal vascular malperfusion and the frequency of placental inflammation and its components, chorioamnionitis, funisitis, villitis and intervillitis in women with and without pre-eclampsia. A total of 733 women had pre-eclampsia and 2334 women had neither hypertension nor proteinuria. In the placentas of women with pre-eclampsia, 57.3% had maternal vascular malperfusion compared with 37.1% in women without pre-eclampsia (p < 0.0001). There was not a significant difference in the prevalence of fetal vascular hypertension between mothers with (17.1%) and without (14.8%, p = 0.6118) pre-eclampsia. When placentas were classified as 'histologically normal' or not, 61.3% of those from pre-eclamptic pregnancies were classified as abnormal, whereas if there was no pre-eclampsia, only 45.0% were classified as histologically abnormal (p < 0.0001). We also considered rates of placental maternal vascular malperfusion in women with and without pre-eclampsia with stillbirth, preterm neonatal death, and term live birth. In women at term with no pre-eclampsia, 16.7% of the placentas had features of maternal vascular malperfusion. This occurred in 79.9% of women with stillbirths with pre-eclampsia compared with 51.8% of those without pre-eclampsia. Maternal vascular malperfusion was present in 49.7% of preterm live births with pre-eclampsia compared with 33.8% without pre-eclampsia. We also evaluated the inflammatory lesions by whether the mother had or did not have pre-eclampsia. When all inflammatory lesions were considered, women with pre-eclampsia had significantly fewer inflammatory lesions than those women without pre-eclampsia (17.1% versus 23.6% p = 0.001). Each of the specific inflammatory lesions was less common in placentas of women with pre-eclampsia than those with chorioamnionitis (16.1% versus 21.9%, p = 0.004) and funisitis (1.5% versus. 5.1%, p = 0.0004). Of placental lesions in women with pre-eclampsia, maternal vascular malperfusion was the most common. Inflammatory lesions were less common in women with pre-eclampsia.

Preterm Delivery and Neonatal Deaths among Anaemic Pregnant Women in the Bolgatanga Metropolis of Ghana.

Preterm deliveries and neonatal deaths as functions of anaemia in pregnancy are of major public health interest. However, data on the prevalence of preterm deliveries and their association with mortality in anaemic pregnant women in the study area are scanty. Thus, the study sought to investigate the prevalence of preterm delivery and neonatal deaths among anaemic pregnant women in the Bolgatanga Regional Hospital in the Upper East Region of Ghana during the past five years. A retrospective study design was adopted, and data were gathered between March and May 2016. Records of women who were anaemic during any trimester of their pregnancy and delivered in the hospital within the last five years were included in the study. In all, two hundred (200) cases were reviewed. Data on the sociodemographic characteristics, health status, and birth outcome of participants were captured, and analyses were conducted using SPSS version 21 while considering significant differences at p < 0.05. The study revealed that more than half of the anaemic women (52.5%, n = 105) had preterm deliveries, while neonatal mortality was 8.5% (n = 17). The proportion of mothers who received dietary or medical intervention for the treatment of anaemia and the number of attendances to antenatal clinics were comparable between preterm and normal-term mothers (p > 0.05). Mothers with preterm deliveries had a higher risk of neonatal mortality (AOR = 13.66, 95% CI = 1.65-113.30, and p=0.015). This study has shown that anaemia in pregnancy increases the risk of preterm delivery and neonatal death. It is recommended that extra care be given to pregnant women with anaemia, while further studies are conducted with a larger sample size to substantiate the claims made in this study.

Preventing eviction during pregnancy: a cost-effectiveness analysis of a theoretical safety-net program

Eviction in pregnancy has been shown to be associated with adverse birth outcomes. A safety net program focused on covering the costs of rent during pregnancy may aid in preventing adverse complications. To evaluate the cost-effectiveness of a program covering the cost of rent to prevent eviction during pregnancy. A cost-effectiveness model using TreeAge software was designed to evaluate the cost, effectiveness, and incremental cost-effectiveness ratio (ICER) associated with eviction compared to no eviction in pregnancy. The cost of eviction from a societal perspective was compared to the annual cost of housing in the no eviction group, which was estimated by the median contract rent in the US from 2021 national census data. Birth outcomes included pre-term birth, neonatal death, and major neurodevelopmental delay. Probabilities and costs were derived from the literature. The cost-effectiveness threshold was set at $100,000/QALY. We performed univariable and multivariable sensitivity analyses to assess the robustness of the results. In our theoretical cohort of 30,000 pregnant individuals aged 15-44 facing eviction annually, the no eviction during pregnancy strategy was associated with 1,427 fewer pre-term births, 47 fewer neonatal deaths, and 44 fewer cases of neurodevelopmental delay compared to eviction. At the median cost of rent in the US, the no eviction strategy was associated increased QALYs and decreased costs. Therefore, the no eviction strategy was the dominant strategy. In univariate sensitivity analysis varying the cost of housing, no eviction remained the cost-effective strategy and was cost-saving when rent was below $1,016 per month. The no eviction strategy is cost-effective and reduces cases of preterm birth, neonatal death, and neurodevelopmental delay. When rent is below the median of $1,016 per month, no eviction is the cost-saving strategy. These findings suggest that policies supporting social programmatic implementation for rent coverage for pregnant people at risk of eviction have the potential to be highly beneficial in reducing costs and disparities in perinatal outcomes.

Causes of Perinatal Deaths in Australia: Slow Progress in the Preterm Period

(Aust N Z J Obstet Gynaecol. 2022;62:511–517) The rate of stillbirth in Australia decreased from 25% to 15% over the last 20 years. Ninety percent of Australian stillbirths are born before 28 gestational weeks (EGA), and the number of deaths following preterm birth in Australia has remained stable. Despite perinatal and neonatal death being relatively similar, many studies attempt to ignore their similarities and focus on one of them. This study researched the impact of EGA on preterm stillbirth and neonatal death to identify where future research should focus.

Analysis of twin pregnancy based on obstetrics and perinatal outcome in a tertiary care hospital in North-East India

Background and Objective: Over the last decade, the incidence of twin pregnancies has been enormously increased. Preterm births and neonatal deaths are associated with twin pregnancies which might be due to prematurity, fetal growth restriction and low birth weight. In the present study, the consequences of twin pregnancy have been analyzed. Methods: This descriptive observational study has been conducted in Silchar Medical College and Hospital in between June 1st 2020 to May 31st 2021.A total of 120 twin pregnant women admitted in maternity ward in labour during the study period. Maternal and perinatal outcome has been analyzed. Result: The result showed that pregnancy complications were remarkably higher. Preterm labour 65.4%, hypertensive disorder of pregnancy 35.2%, premature rupture of membrane 30.2%, anaemia 44.1%, antepartum haemorrhage 7.5%, liquor abnormalities 11.6%, cesarean section 46.7%, postpartum haemorrhage 18.3%, gestational diabetes mellitus 5.8% are the complications encountered. About 10.1% of first twins and 17% of second twins were asphyxiated (APGAR score <7) at 5 minutes of birth. The perinatal mortality rate was 10.2% for first twin and 16.2% for second twin. Very low birth weight (<1500 g) were 18.3% of 1st twins and 24.2% of 2nd twins. Low birth weight (1500 to 2000g) 41.7% of 1st twins and 38.3% of 2nd twins. Presentations during delivery of twin babies were vertex-vertex 50.8%, vertex-non vertex in 29.1%, non-vertex 1st twins 19.8%. Conclusion: Institutional deliveries are essential in twin pregnancies because twin pregnancies are considered as high-risk pregnancies. Early diagnosis, adequate ante-natal, intra-natal and postnatal care are important to boost the outcome.

COVID-19 vaccination is effective at preventing severe illness and complications during pregnancy

COVID-19 vaccination is effective at preventing severe illness and complications during pregnancy

Survival and predictors of mortality among preterm neonates in Northern Ethiopia: A retrospective follow-up study.

In the year 2015, more than one-third of neonatal deaths caused by prematurity was recorded worldwide. Despite different kinds of efforts taken at the global and local levels to reduce neonatal mortality, it remains high with low reduction rates, especially in low- and middle-income countries like sub-Saharan Africa and South Asia. Therefore, this study aims to assess the survival status and predictors of mortality among preterm neonates. A retrospective follow-up study was conducted on randomly selected 561 preterm neonates. Data were extracted from patient records using a pretested checklist. Data entry and analysis were done using Epi-Data Version 4.4.2.1 and Stata version 14, respectively. The Cox proportional hazard regression model was fitted to identify the predictors of mortality. A hazard ratio with a 95% confidence interval (CI) was estimated and p-values < 0.05 were considered statistically significant. The proportion of preterm neonatal deaths was 32.1% (180) with an incidence of 36.6 (95% CI: 31.6-42.4) per 1,000 person days. The mean survival time was 18.7 (95% CI: 17.7-19.9) days. Significant predictors for time to death of preterm neonates were respiratory distress syndrome [adjusted hazard ratio (AHR): 2.04; 95% CI: 1.48-2.82], perinatal asphyxia (AHR: 2.13; 95% CI: 1.32-3.47), kangaroo mother care (AHR: 0.14; 95% CI: 0.08-0.24), and gestational age (AHR: 0.85; 95% CI: 0.80-0.90). Preterm neonatal death is still a major public health concern. Respiratory distress syndrome, perinatal asphyxia, kangaroo mother care, and gestational age were independent significant predictors for time to death, as found in this study. Hence, priority must be given to neonates with the above illnesses and strengthen the management and care of preterm neonates.

Impact of eviction during pregnancy: a cost-effectiveness analysis

Eviction in pregnancy has been associated with adverse birth outcomes. We aimed to evaluate the cost-effectiveness of eviction versus no eviction of individuals during pregnancy. A cost-effectiveness model using TreeAge software was designed to evaluate the cost, effectiveness, and incremental cost-effectiveness ratio (ICER) associated with eviction relative to no eviction in pregnancy. The estimated cost of eviction was compared to the annual median rent in the US to represent the cost of housing in the no eviction group. Birth outcomes included pre-term birth, neonatal death, and major neurodevelopmental delay. Probabilities and costs were derived from the literature. A cost-effectiveness threshold was set at $100,000/QALY, and sensitivity analyses were conducted to assess the robustness of the results. In our theoretical cohort of 50,000 pregnant individuals aged 18-44 facing eviction annually, no eviction during pregnancy was associated with 3,374 fewer pre-term births, 20 fewer neonatal deaths, and 30 fewer cases of neurodevelopmental delay compared to eviction. At the median cost of rent in the US, the eviction strategy was associated with lower QALYs but also lower costs (Table 1). Despite the lower cost of eviction, no eviction was the cost-effective strategy, with an ICER of $37,087. In univariate sensitivity analysis varying the cost of housing, no eviction remained the cost-effective strategy and became cost-saving when annual rent reached below $12,000 (Figure 1). The no eviction strategy is cost-effective and reduces cases of pre-term birth, neonatal death, and neurodevelopmental delay. When rent was lowered to $12,000, eviction became the cost-saving strategy. This rent price may be closer to the actual cost of rent for those facing eviction. These findings demonstrate that policy interventions to provide housing and prevent eviction of pregnant individuals are necessary and represent an actionable target to reduce costs and improve birth outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Recombinant protein diannexin prevents preeclampsia-like symptoms in a pregnant mouse model via reducing the release of microparticles.

Preeclampsia (PE) is characterized by placenta-mediated pregnancy complication. The only effective treatment for PE is the delivery of the placenta. However, this treatment may cause preterm birth and neonatal death. Therefore, preventing PE is needed. The mechanism of PE involves abnormal placentation, which leads to the release of anti-angiogenic and inflammatory mediators into maternal circulation. These mediators contribute to systemic vascular dysfunction, inflammatory responses, and excessive thrombin generation. Microparticles (MPs) are reportedly involved in PE by promoting the thromboinflammatory response. This study describes a strategy to prevent PE by reducing MP release using the recombinant protein, diannexin. Results showed that the patients with PE had elevated MP number and procoagulant activity and increased NLRP3 inflammasome activation. Additionally, diannexin remarkably reduced the release of MPs from activated cells by binding to phosphatidylserine exposed on the surface of activated cells. Moreover, in vivo results showed that diannexin could prevent PE-like symptoms by decreasing MPs and NLRP3 inflammasome activation in pregnant mice. Furthermore, diannexin effectively inhibited trophoblast cell activation and NLRP3 inflammasome activation in vitro. These findings suggested that diannexin inhibited MP release and might be an effective therapeutic strategy for preventing PE.

Higher Dietary Intake of Animal Protein Foods in Pregnancy Is Associated with Lower Risk of Adverse Birth Outcomes

The prevalence of adverse birth outcomes is highest in resource-limited settings such as sub-Saharan Africa. Maternal consumption of diets with adequate nutrients during pregnancy may protect against these adverse outcomes. The objective was to determine the association between maternal dietary consumption of animal source foods (ASFs) and the risk of adverse birth outcomes among HIV-negative pregnant women in Tanzania. Using dietary intake data from 7564 HIV-negative pregnant women, we used Poisson regression with the empirical variance (generalized estimating equation) to estimate the RR of adverse birth outcomes-preterm birth, very preterm birth, small for gestational age (SGA), low birth weight (LBW), stillbirth, and neonatal death-for higher and lower frequency of ASF intake. Median daily dietary intake of animal protein was 17 g (IQR: 1-48 g). Higher frequency of ASF protein intake was associated with lower risk of neonatal death (quartile 4 compared with quartile 1; RR: 0.59; 95% CI: 0.38, 0.90; P-trend = 0.01). Higher fish intake was associated with lower risk of very preterm birth (high tertile compared with low; RR: 0.76; 95% CI: 0.58, 0.99; P-trend = 0.02). Any meat intake was protective of preterm birth (RR: 0.73; 95% CI: 0.65, 0.82; P < 0.001), very preterm birth (P < 0.001), LBW (P < 0.001), and neonatal death (P = 0.01) but was associated with increased risk of SGA (RR:1.19; 95% CI: 1.01, 1.36; P = 0.04). Any egg intake was protective of very preterm birth (RR: 0.50; 95% CI: 0.31, 0.83; P = 0.01) as compared with no egg intake. Finally, any dairy intake was associated with lower risk of preterm birth (RR: 0.82; 95% CI: 0.68, 0.98; P = 0.03) and very preterm birth (RR: 0.53; 95% CI: 0.34, 0.84; P = 0.01). Higher frequency of dietary intake of ASF is associated with lower risk of adverse birth outcomes in urban Tanzania. Promoting prenatal dietary intake of ASF may improve birth outcomes in this region and similar resource-limited settings.

A community based prospective study on thyroid dysfunction among pregnant females and its effect on maternal and neonatal outcome

Background: Thyroid disorders are often overlooked in pregnancy because of their non-specific symptoms and the hypermetabolic state of pregnancy. The laboratory measurements of thyroid function play an important role in the assessment of maternal thyroid health. Thyroid disorders can have grievous effect on mother and new-borne which can be prevented. The study was aimed to find the prevalence of thyroid dysfunction among pregnant females and its effect on maternal and neonatal outcome.Methods: A prospective study was conducted from August 2019 to October 2020 among 360 pregnant females in the rural fields practice area of a medical college. Thyroid function test was done in all pregnant females and the maternal and neonatal outcome was noted.Results: 20.31% of the pregnant females were found to be suffering from thyroid dysfunction which is approximately 1/5th of the total sample. Out the total females with thyroid dysfunction maximum females suffered from subclinical hypothyroidism that is 10.94% while 1.56% had overt hypothyroidism. 1.88% and 5.94% had subclinical and overt hyperthyroidism respectively. Postpartum haemorrhage, pre term delivery, abortion and neonatal deaths were more common in females with thyroid dysfunction as compared to euthyroid females although not statistically significant.Conclusions: Though pregnancy outcome was not found to be significantly adverse among females with thyroid dysfunction, very high prevalence of thyroid dysfunction among pregnant warrants its detection during antenatal care to be uniformly included in peripheral health care centres.

Socioeconomic differences in perinatal health outcomes: perinatal health surveillance through a health-equity prism

Abstract Background Socioeconomic status (SES) is strongly associated with perinatal health outcomes, perpetuating intergenerational health inequalities. Our aim was to assess the utility of population data in Europe to monitor social inequalities in key perinatal health indicators. Methods Using the PHIRI federated analysis protocol to aggregate routine birth data from across Europe, we collected data on selected perinatal health indicators by SES from 2015 to 2020. Mothers’ education level (primary/lower secondary; upper secondary; postsecondary) was the preferred SES indicator; if unavailable, parents’ occupation or area-based deprivation scores were provided. The International Standard Classification of Occupations was used to group parents’ occupations into 4 categories, while area-based deprivation scores were measured in quintiles. For each country, we calculated risk ratios (RR) for preterm birth, stillbirth, neonatal death and caesarean delivery (CD) comparing the most with the least disadvantaged group Results 17 countries provided data on maternal education, 5 on area-based deprivation, 1 on parents’ occupation and 2 could not provide data. For preterm birth, stillbirth and neonatal death, lower SES was associated with worse outcomes with most RR between lowest and highest groups in the range of 1.5 to 3.0. In contrast, in some countries, such as Croatia, Latvia, Lithuania and Spain, CD rates were higher for socially advantaged groups whereas the gradient was reversed in others (Denmark, Luxembourg, the Netherlands and Italy). Conclusions European countries can provide perinatal health indicators by SES, revealing marked socioeconomic inequalities in perinatal health. The differing SES gradient between countries for CD raise questions about care organization and clinical practice. Further exploration of the harmonization of differing SES measure across countries is required, while countries that do not monitor SES data should aim to improve existing systems.