Reduction In Low Birth Weight Research Articles

Study of Factors Associated with Low Birth Weight in the Bounkiling Health District in 2020 (Senegal)

<i>Introduction</i>: Neonatal mortality is particularly high in developing countries. Low birth weight (LBW) is a major public health problem in both developing and developed countries. It accounts for a significant proportion of neonatal deaths. The aim of this study was to determine the factors associated with the occurrence of low birth weight in the Bounkiling health district in 2020. <i>Methodology</i>: This was a retrospective case-control study of the various factors associated with low birth weight, based on women's delivery records from maternity units in the Bounkiling health district throughout 2020. Mothers' socio-demographic characteristics, obstetrical and medical history, and information on the health status of the newborn in the case group (weight less than 2,500 grams) were compared with those in the control group (weight greater than or equal to 2,500 grams). Bivariate and multivariate analyses were performed using Épi info 7 software to identify risk factors associated with LBW. <i>Results</i>: The study showed that low birth weight accounted for 97.05% of LBW, the sex ratio was 0.87 in favor of girls, the Apgar score at birth was not good (below 7) for 31.43% of newborns. Teenage mothers accounted for 17.08%. Women with no schooling accounted for 71.34%, and those living in households with a monthly income of less than 50,000 CFA francs per month were 63.71%. Results of the multivariate analysis showed that the risk factors for LBW (p < 0.05) were female sex of the newborn (AOR=1.59 with CI=1.07 - 2.35), Apgar score at birth (AOR=2.79 with CI=1.77 - 4.41), young maternal age under 19 (AOR=2.42 with CI=1.43- 4.12), household income under 50,000 CFA francs, (AOR=1.97 with CI=1.27-3.04), maternal history of low birth weight (AOR=3.62 with CI=2.02-6.50), physical labor during pregnancy (AOR=1.80 with CI=1.20 - 2.69). <i>Conclusion</i>: Improving neonatal health through a reduction in LBW will depend on intensifying the implementation of strategies focused on adolescent reproductive health, strengthening communication with adolescent girls and community leaders on the issue of early marriage and pregnancy, improving pregnancy monitoring at health facilities and raising the socio-economic level of women through their empowerment.

Assessment of Nutritional Status Using Composite Index of Anthropometric Failure (CIAF) Among Under-Five Children from An Urban Slum of Southern India: A Cross-Sectional Study

Introduction: NFHS-5 Telangana reports underweight, stunting, and wasting among under 5 children as 31.8%, 33.1%, and 21.7% respectively. Composite Index of Anthropometric Failure is an aggregate indicator that excludes children with anthropometric failure and includes children who are wasted, stunted, or underweight, and their combinations. The objectives were to determine the prevalence of anthropometric failures and to find its determinants among under-five children in an urban slum area of Hyderabad. Methodology: A cross sectional study was conducted among 310 under 5 children residing in the urban-slum area of Hyderabad. Probability proportionate to size sampling was used. Using questionnaire and standard operating procedures, socio-demographic profile, health details and nutritional assessment was done. Statistical analysis was done using SPSS version 26. Results: The prevalence of anthropometric failure is noted to be 39.6%. The prevalence of stunting, underweight and wasting were found to be 20.7%, 26.8% and 12%, respectively. The illiteracy of father [AOR:2.94(CI: 1.31-6.62); p-value=0.009], low birth weight [AOR:2.024(CI: 1.253-3.26); p-value=0.004], not exclusively breastfed [AOR:4.291(CI:1.55-11.904); p-value=0.005] and deficient calorie intake [AOR: 2.079(CI:1.103-3.906); p-value=0.023] were found to be the significant predictors of Anthropometric failure. Conclusion: Under nutrition is an important public health problem with 40% prevalence in urban slum of Telangana. Enhancing the literacy of fathers, reduction in low birth weight, better IYCF practices and providing calorie adequate diet will aid in enhancing children's nutritional status.

Increase in birthweight coverage of neonatal deaths is needed to monitor low birthweight prevalence in India: lessons from the National Family Health Survey

BackgroundLow birthweight (LBW), defined as birthweight < 2500gms, is the largest contributor to the malnutrition disability-adjusted-live-years in India. We report on the inadequacy of birthweight data, which is a significant barrier in the understanding of LBW epidemiology, to address malnutrition in India.MethodsData from the recent round of the National Family Survey (NFHS-5) were utilised. Birthweight of livebirths in the last 5 years was documented in grams either from the health card or based on mother’s recall. We computed the coverage of birthweight measurement availability and the extent of heaping (values of 2500, 3000 and 3500gms) by the place of delivery and by the survival of newborn during the neonatal period. Heaping of > 55% was considered as poor-quality birthweight data. LBW prevalence per 100 livebirths was estimated and extrapolated for under-reporting of birthweight. Findings are reported for India and its 30 states.ResultsBirthweight measurement coverage irrespective of the place of delivery was (89·8%; 95% CI 89·7–90) for India, and varied by 2 times among the states with the highest coverage in Tamil Nadu (99·3%) and the lowest in Nagaland (49·7%). Home deliveries had the least coverage of birthweight measurement (49.6%; 95% CI 49.0–50.1) as compared with public health facility (96.3%; 95% CI 96.2–96.3) and private health facility (96%; 95% CI 95.8–96.1) deliveries. This coverage was 66·5% (95% CI 65·2–67·7) among neonatal deaths as compared with 90.4 (95% CI 90.3–90.6) for livebirths who survived the neonatal period for India. The proportion of health card as the data source increased for livebirths born in year 2015 to year 2020 but then dropped for livebirths born in year 2021 (p < 0.001). The proportion of heaping was 52·0% (95% CI 51·7–52·2) in the recorded birthweight for India, and heaping > 55% was seen in 10 states irrespective of the type data source; and 3 states in addition had heaping > 55% in mother’s recall. LBW prevalence was estimated at 17·4% (95% CI 17·3–17·6) for India, and ranged from 4.5% in Nagaland and Mizoram to 22.5% in Punjab for livebirths for whom birthweight was available. We estimated LBW at 77.8% for whom birthweight was not available, and the adjusted LBW prevalence for all livebirths was estimated at 23.5% (95% CI 23.3–23.8) for India.ConclusionsWithout measuring birthweight for every newborn irrespective of the survival and place of delivery, India may not able to address reduction in low birthweight and neonatal mortality effectively to meet global or national targets.

Multiple micronutrient supplementation cost-benefit tool for informing maternal nutrition policy and investment decisions.

Antenatal multiple micronutrient supplementation (MMS) is an intervention that can help reach three of the six global nutrition targets, either directly or indirectly: a reduction in low birth weight, stunting, and anaemia in women of reproductive age. To support global guideline development and national decision-making on investments into maternal nutrition, Nutrition International developed a modelling tool called the MMS cost-benefit tool to help users understand whether antenatal MMS is better value for money than iron and folic acid supplementation (IFAS) during pregnancy. The MMS cost-benefit tool can generate estimates on the potential health impact, budget impact, economic value, cost-effectiveness and benefit-cost ratio of investing in MMS compared to IFAS in LMICs. In the 33 countries with data included in the tool, the MMS cost-benefit tool shows that transitioning is expected to generate substantial health benefits in terms of morbidity and mortality averted and can be very cost-effective in multiple scenarios for these countries. The cost per DALY averted averages at US$ 23.61 and benefit-cost ratio ranges from US$ 41-US$ 1304: $1.0, which suggest MMS is good value for money compared with IFAS. With its user-friendly design, open access availability, and online data-driven analytics, the MMS cost-benefit tool can be a powerful resource for governments and nutrition partners seeking timely and evidence-based analyses to inform policy-decision and investments towards the scale-up of MMS for pregnant women globally.

Multiple Factors as Mediators of the Reduced Incidence of Low Birth Weight in an Urban Clinic Population

A five year prospective observational study was initiated in 1985 at Howard University to describe the nutritional, clinical, dietary, lifestyle, environmental, and socioeconomic characteristics of women who enrolled in the hospital prenatal clinic. The participants were nulliparous, between the ages of 18 and 35 years, free of diabetes and abnormal hemoglobins (sickle cell disease, thalassemia, and hemoglobin C), and had been admitted prior to the 29th week of gestation. During the three year period from 1985-1988, the incidence of low birth weight (LBW) in 239 deliveries to project participants was 8.3%, whereas that of women simultaneously enrolled in the prenatal clinic with the same eligibility requirements, but not recruited for the research project, was 21.9% (P = 0.001). The incidence of LBW in infants of African American women with these eligibility requirements who were delivered by private physicians but were not enrolled in the project, was 6.3%. The reduction in LBW of infants delivered to participants in this study is attributed to the enhanced social and psychological support by project staff during their pregnancies. The caring, sensitive demeanor of the research project staff may have empowered the participants to (a) give greater compliance (91 vs. 70%) in the ingestion of the routine physician-prescribed vitamin/mineral supplement, which provided nutrients low (less than 70% of the 1989 RDAs) in their customary diets, such as folate, pyridoxine, iron, zinc, and magnesium and (b) show greater accountability in keeping prenatal clinic appointments.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk of low birthweight associated with the timing and frequency of antenatal care visits in Lao PDR: a retrospective cohort study

BackgroundAntenatal care (ANC) plays an important role in preventing low birthweight (LBW). Whereas the government of Lao People’s Democratic Republic (Lao PDR) has committed to increasing the usage of ANC, little attention has been given to the early initiation of ANC. The present study assessed the influence of delayed and fewer ANC visits on LBW in the country.MethodsThis is a retrospective cohort study conducted at Salavan Provincial Hospital. Study participants were all pregnant women who gave birth at the hospital between 1 August 2016 and 31 July 31 2017. Data were collected from medical records. Logistic regression analyses were performed to quantify the relationship between ANC visits and LBW. We also investigated factors associated with inadequate ANC visits: first ANC visit after the first trimester or < 4 ANC visits.ResultsThe mean birth weight was 2808.7 g [standard deviation: SD 455.6]. Among 1804 participants, 350 (19.4%) had babies with LBW, and 147 (8.2%) had inadequate ANC visits. In multivariate analyses, compared to participants with adequate ANC visits, those with ≥ 4 ANC visits and the first ANC visit after the second trimester, those with < 4 ANC visits, and those with no ANC visits had higher odds ratios (ORs) of LBW: 3.77 (95% confidence interval: CI = 1.66–8.57), 2.39 (95% CI = 1.18–4.83) and 2.22 (95% CI = 1.08–4.56), respectively. Younger maternal age (OR 1.42; 95% CI = 1.07–1.89), government subsidisation (OR 2.69; 95% CI = 1.97–3.68) and ethnic minority (OR 1.88; 95% CI = 1.50–2.34) were associated with increased risk of insufficient number of ANC visits after adjusting for covariates.ConclusionsFrequent and early initiation of ANC was associated with a reduction in LBW in Lao PDR. Encouraging childbearing-aged women to receive sufficient ANC at proper timing may lead to a reduction in LBW and improvement in short- and long-term health outcomes of neonates. Special attention will be needed for ethnic minorities and women in lower socioeconomic classes.

Does Neighborhood Crime Mediate the Relationship Between Neighborhood Socioeconomic Status and Birth Outcomes? An Application of the Mediational G-Formula.

While the link between living in a low-socioeconomic status (SES) neighborhood and higher risk of adverse birth outcomes has been well established, the underlying mechanisms remain poorly understood. Using the parametric g-formula, we assessed the role of neighborhood crime as a potential mediator of the relationship between neighborhood SES and birth outcomes using data on singleton births occurring in the Netherlands between 2010 and 2017 (n=1,219,470). We estimated total and mediated effects of neighborhood SES on small-for-gestational-age (SGA) birth, low birth weight (LBW), and preterm birth (PTB) for 3 types of crime (violent crimes, crimes against property, and crimes against public order). The g-formula intervention settings corresponded to a hypothetical improvement in neighborhood SES. A hypothetical improvement in neighborhood SES resulted in a 6.6% (95% CI: 5.6, 7.5) reduction in the proportion of SGA birth, a 9.1% (95% CI: 7.6, 10.6) reduction in LBW, and a 5.8% (95% CI: 5.7, 6.2) decrease in PTB. Neighborhood crime jointly accounted for 28.1% and 8.6% of the total effects on SGA birth and LBW, respectively. For PTB, we found no evidence of mediation. The most relevant pathways were crimes against property and crimes against public order. The results indicate that neighborhood crime mediates a meaningful share of the relationship between neighborhood SES and birth outcomes.

STUDY OF EFFECT OF ANTENATAL STEROIDS ON MECHANICALLY VENTILATED LOW BIRTH WEIGHT NEONATES WITH RESPIRATORY DISTRESS ADMITTED TO NEONATAL INTENSIVE CARE UNIT(NICU)

Background: Low birth weight (LBW) is dened as a birth weight of less than 2.5kg as per World Health Organization (WHO)1. Low birth weight (LBW) is a major public health problem in developing countries including India. In India, 30-35% of babies are LBW and more than half of them are full term babies2. Reduction of low birth weight forms an important contribution to the Millennium Development Goal (MDG) for reducing child mortality3. Corticosteroids administration before anticipated preterm births is one of the most important antenatal therapies available to improve neonatal outcomes. Corticosteroids alter the structural and biochemical physiology of neonates, like surfactant production and lung maturation and thus reduces the requirement and duration of mechanical ventilation. Aims And Objectives: 1.To know the effect of antenatal steroids in minimizing the duration of ventilation in LBW neonates 2.To know the effect of antenatal steroids on assisting in early extubation of LBW neonates. All Low birth weight neonates &lt;2.5 kg who were intubated and on vent Inclusion Criteria: Exclusion Criteria: ilator support. 1.Major congenital anomalies 2.Extubated as a part of withdrawal of care. This Materials And Methods: study was a Prospective Observational Study and was conducted in Rajarajeswari Medical College and Hospital, Bangalore for a duration of 18 months between January 2021 and June 2022.SAMPLE SIZE: n=54, Sample size calculated using considering 95% condence interval and 10% precision. All the parameters Results: i.e., birth weight, gestational age, gender, presence of maternal comorbidities, surfactant and antenatal steroids showed signicant association with number of days of mechanical ventilation in the study. This study was conducted Conclusion: to study the effect of antenatal steroids on mechanical ventilation in low-birth-weight neonates admitted to neonatal intensive care unit and it was found that antenatal steroids had signicant effect on duration of mechanical ventilation; this study has also recognized the factors involved in prolonging the days of mechanical ventilation such as prematurity, doses of antenatal steroids received, low birth weight, lower gestational ag . Recognising such factors can help in preventing complications among the newborns thereby reducing the number of days of mechanical ventilation

Divergence in time trends between nutrition and health status of Indian children: an enigma?

India has been food secure and children had access to essential health and nutrition services for four decades but under-nutrition rates in children continue to be high. Despite the high prevalence of low birthweight (LBW) and under-nutrition, under-five mortality rates are relatively low: the ‘South Asian enigma’. Data from research studies and large-scale nutrition and health surveys were analysed and reviewed to assess: dimensions, determinants and time trends of under-nutrition in under-five children, functional decompensations associated with LBW and under-nutrition, factors responsible for ‘South Asian enigma’, and progress towards Sustainable Development Goals (SDG) for child nutrition and health. Neonates born with low weight and length, follow a lower trajectory of growth throughout childhood; this was the major factor responsible for the high under-nutrition rates in children. Breast feeding was nearly universal; about 2/3rd of infants were solely breast-fed at 5 months; but both complementary feeds and adult food given to children were inadequate and lacked diversity. This resulted in a rise in under-nutrition rates between 12-23 months. In 24-59 months there was no further rise in under-nutrition rates. Moderate under-nutrition is not associated with increase in risk of infections; health care for infection was available and utilised; therefore, mortality rates were low. India will not be able to achieve the SDG targets for reduction in low birthweight or under-nutrition but is likely to achieve the targets for reduction in food insecurity and under-five mortality.

A cross sectional study on morbidities pattern among the low birth weight infants in the rural field practice area of a tertiary care teaching hospital in Karnataka

Background: Low birth weight (LBW) is an important known risk factor associated with neonatal morbidity and mortality. LBW infants are at risk of growth impairment and poor cognitive development. The reduction of LBW is an important contribution to the achievement of Sustainable Development Goal (SDG) for reducing child mortality. Objective was to determine the morbidity pattern among the low birth weight infants in the rural field practice area of Mandya Institute of Medical Sciences, Mandya.Methods: A cross sectional study was conducted over a period of one year in the rural field practice area of Mandya Institute of Medical Sciences (MIMS), Mandya. Using a pre-tested semi structured questionnaire, data was collected by interviewing parents/ caregivers of infants at their homes. Data was collected from households of 166 infants by house to house visit after obtaining informed consent. Descriptive statistics and inferential statistics like chi-square test were used for analysis of the data.Results: The common morbidity among LBW infants were acute respiratory infections (18.7%) and fever (12.5%). Most of the LBW infants had delayed vaccination (50%) and developmental milestones as compared to that of the normal birth weight infants.Conclusions: Acute respiratory infections (18.7%) and fever (12.5%) were the common morbidities among the infants. Delayed vaccination (50%) and delayed developmental milestones were common among LBW infants. Health care services should be strengthened in rural area to reduce the morbidities among the LBW infants.

238 The association between quitting electronic cigarette use in pregnancy and the risk of preterm birth and low birth weight

OBJECTIVES/GOALS: Nearly half of mothers who report electronic (e)-cigarette use during pregnancy believe e-cigarettes are less harmful than traditional cigarettes. We aim to determine the association of quitting e-cigarette use in pregnancy with the risk of preterm birth and low birth weight. METHODS/STUDY POPULATION: We conducted a cross-sectional study of women participating in the Pregnancy Risk Assessment Monitoring System and with live singleton birth during 2016-2019. Women were classified based on their e-cigarette use: before pregnancy only (quitters), last three months of pregnancy only (initiators), at both times (sustained users), and neither time (non-users). We used a modified Poisson regression to determine the association between quitting e-cigarette use and preterm birth (&lt;37 weeks) and low birth weight (&lt;2,500 grams) adjusting for demographic, social-economic, and behavior-related risk factors. Analyses were weighted to account for the survey design and non-response. RESULTS/ANTICIPATED RESULTS: Based on 150,950 women who responded to the survey, there were estimated 2.9% quitters, 0.2% initiators, 1.0% sustained users, and 95.9% non-users in the U.S. Compared to sustained e-cigarette users, quitters had a similar risk in preterm birth (adjusted risk ratio [ARR]: 0.84, 95% confidence interval [CI]: 0.65, 1.08) and a significantly reduced risk in low birth weight (ARR: 0.77, 95%CI: 0.61, 0.97) adjusting for traditional cigarette use, age, race/ethnicity, education, marital status, family income, prior preterm birth, prior live births, BMI prior to pregnancy, pregnancy weight gain, kotelchuck index, multivitamin use, drinking prior to pregnancy, year of birth, and residential state. DISCUSSION/SIGNIFICANCE: As FDA authorizes the sales of certain e-cigarettes, women smokers may switch to e-cigarettes, believing they are reducing harm. Our study shows that quitting e-cigarette use is associated with a reduction of low birth weight. Clear messaging is needed to help women cease e-cigarette use in pregnancy.

Nutritional status of Indian pre-school children and WHO nutrition targets for 2025

Background: India has been food secure and has been implementing food supplementation programmes for decades but prevalence of under-nutrition in pre-school children is high. The WHO has set nutrition targets for reduction in low birthweight, stunting, wasting and halting rise in over-nutrition in children to be achieved by 2025.Methods: District level household survey 4 and annual health survey (2013-2015) undertook height and weight measurements in pre-school children (DLHS4 74717 and AHS 139157 children). Mean weight, height and BMI-for-age were computed for girls and boys in 0-5 years and compared with WHO MGRS growth standards. Prevalence of stunting, under-weight, wasting, over-nutrition, combined stunting and wasting were computed in each survey in relation to age.Results: The mean height and weight-for-age in boys and girls during 6-60 months was around the -2SD and mean BMI-for-age was between the mean and -1SD of the WHO standards. Frequency distribution of Z scores for all three indices in Indian children were to the left of the WHO standards. In under-five children stunting rates were highest, wasting rates lower and over-nutrition rates the lowest. Prevalence of stunting increased and wasting decreased with increasing age of the children. Prevalence of under-nutrition was higher in children surveyed in AHS.Conclusions: It might not be possible to achieve rapid reduction in low birthweight or stunting. It might be possible to achieve the targets for sustained reduction in wasting in some states. Early detection and management of over-nutrition in children can prevent the rise in over-nutrition.

U-Shaped Association between Maternal Hemoglobin and Low Birth Weight in Rural Bangladesh.

ABSTRACT.Low birth weight (LBW) is associated with a higher risk of neonatal mortality and the development of adult-onset chronic disease. Understanding the ongoing contribution of maternal hemoglobin (Hgb) levels to the incidence of LBW in South Asia is crucial to achieve the World Health Assembly global nutrition target of a 30% reduction in LBW by 2025. We enrolled pregnant women from the rural Tangail District of Bangladesh in a Maternal Newborn Health Registry established under The Global Network for Women’s and Children’s Health Research. We measured the Hgb of pregnant women at enrollment and birth weights of all infants born after 20 weeks gestation. Using logistic regression to adjust for multiple potential confounders, we estimated the association between maternal Hgb and the risk of LBW. We obtained Hgb measurements and birth weights from 1,665 mother–child dyads between July 2019 and April 2020. Using trimester-specific cutoffs for anemia, 48.3% of the women were anemic and the mean (±SD) Hgb level was 10.6 (±1.24) g/dL. We identified a U-shaped relationship where the highest risk of LBW was seen at very low (< 7.0 g/dL, OR = 2.00, 95% CI = 0.43–7.01, P = 0.31) and high (> 13.0 g/dL, OR = 2.17, 95% CI = 1.01–4.38, P = 0.036) Hgb levels. The mechanisms underlying this U-shaped association may include decreased plasma expansion during pregnancy and/or iron dysregulation resulting in placental disease. Further research is needed to explain the observed U-shaped relationship, to guide iron supplementation in pregnancy and to minimize the risk of LBW outcomes.

State Policies, Racial Disparities, and Income Support: A Way to Address Infant Outcomes and the Persistent Black-White Gap?

Low birth weight and preterm births vary by state, and Black mothers typically face twice the risk that their white counterparts do. This gap reflects an accumulation of psychosocial and material exposures that include interpersonal racism, differential experience with area-level deprivation such as residential segregation, and other harmful exposures that the authors refer to as "institutional" or "structural" racism. The authors use logistic regression models and a dataset that includes all births from 1994 to 2017 as well as five state policies from this period-Aid to Families with Dependent Children/Temporary Aid for Needy Families, housing assistance, Medicaid, minimum wage, and the earned income tax credit (EITC)-to examine whether these state social policies, designed to provide a financial safety net, are associated with risk reduction of low birth weight and preterm birth to Black and white mothers, and whether variations in state generosity attenuate the racial inequalities in birth outcomes. The authors also examine whether the relationship between state policies and racial inequalities in birth outcomes is moderated by the education level of the mother. We find that the EITC reduces the risk of low birth weight and preterm birth for Black mothers. The impact is much less consistent for white mothers. For both Black and white mothers, the benefits to birth outcomes are larger for mothers with less education.

The association of in-utero exposure to ambient fine particulate air pollution with low birth weight in India

A growing body of research indicates that in-utero exposure to ambient fine particulate matter (PM2.5) is a risk factor for low birth weight (LBW). However, research on India, where the high and rising level of ambient air pollution is a significant health concern, is limited. In this study, we analyze the association between ambient PM2.5 and LBW in India. We match data on birth weight from the National Family and Health Survey (NFHS) conducted in India in 2015–16 with high-resolution spatial data on annual ambient PM2.5 concentration to calculate in-utero exposure based on the residential location of each child. We estimate the association of in-utero exposure to ambient PM2.5 with birth weight and LBW, after adjusting for child level, maternal, and household level characteristics that predict birth weight. In our sample (n = 149 416), in comparison to the reference category of in-utero PM2.5 level less than 26.7 µg m−3, the adjusted OR of LBW increases non-linearly from 1.098 (95% CI: 0.954, 1.263) for children in the exposure band 39.3–44.7 µg m−3 (i.e., the fourth octile) to 1.241 (95% CI: 1.065, 1.447) for those in the exposure band 44.7–51.6 µg m−3 (i.e., the fifth octile) and 1.405 (95% CI: 1.126,1.753) for those with in-utero PM2.5 level greater than 77.3 µg m−3 (i.e., the last octile). Our findings show that exposure to ambient PM2.5 is strongly associated with LBW in India and suggest that policies that improve air quality may be necessary for achieving the World Health Assembly target of 30% reduction in LBW by 2025.

Evaluation of The Manitoba Healthy Baby Prenatal Benefit: Is It Improving Birth and Early Childhood Outcomes for Metis Families?

IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), a prenatal income supplement. Research has demonstrated positive outcomes associated with HBPB, but it remains unknown if Metis women and children – who are of mixed European and Aboriginal descent and one of the most marginalized populations in Canada -- benefit from the program.&#x0D; Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to determine the impact of HBPB on Metis newborn and early childhood outcomes. We included all Metis women giving birth in Manitoba 2003-2011 who received income assistance during pregnancy (n=4,852), adjusting for differences between those receiving (n=3,681) and not receiving (n=1,171) HBPB with propensity score weighting. We used multi-variable regressions to compare outcomes between groups: breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, birth hospitalization length of stay (LOS), neonatal readmissions, infant hospitalizations, vaccinations at age 1 and 2, and child development scores at kindergarten.&#x0D; ResultsHBPB receipt was associated with reductions in low birth weight (adjusted Relative Risk (aRR): 0.74 (95% CI: 0.58-0.94)) and preterm births (aRR: 0.78 (0.65-0.94)), and increases large-for-gestational age births (aRR: 1.21 (1.06-1.39)) and neonatal readmissions (aRR: 1.58 (1.05-2.37)). Birth hospitalization LOS was lower for newborns whose mothers received HBPB (Mean Difference 0.29 days). HBPB was associated with increases in vaccinations for children aged 1 (aRR: 1.08 (1.00-1.15)) and 2 (aRR: 1.12 (1.05-1.18)). No significant associations were found for small-for-gestational age births, Apgar scores, breastfeeding initiation, infant hospitalizations or child development scores.&#x0D; Conclusion / ImplicationsA modest unconditional prenatal income supplement to low-income Metis women was associated with improved birth outcomes and child vaccinations; however, an association with increased neonatal readmissions warrants further exploration. Lack of significant associations between HBPB and child development measures suggests more sustained support may be necessary to improve longer-term outcomes.

Effectiveness of wheat soya blend supplementation during pregnancy and lactation on pregnancy outcomes and nutritional status of their infants at 6monthsof age in Thatta and Sujawal districts of Sindh, Pakistan: a cluster randomized-controlled trial.

We aimed to assess the effectiveness of wheat soya blend plus (WSBP) provided during pregnancy and lactation on weight gain during pregnancy, reduction of low birthweight (LBW), and improvement in nutritional status in infants at 6months of age in Thatta and Sujawal districts of Sindh, Pakistan. A cluster randomized-controlled trial was conducted in Thatta and Sujawal districts in Pakistan from August 2014 to December 2016. A total of 2030 pregnant women were enrolled in the study. These women and their infants were followed during pregnancy and first 6months of life. Pregnant women received a monthly ration of 5kg (i.e., 165g/day) of WSB + during pregnancy and the first 6months of their lactation period. There was no difference in weight gain during pregnancy between the intervention and control groups (n = 496, 326.7g/week 95% CI 315.2-338.1 vs. (n = 507, 306.9g/week, 95% CI 279.9-333.9 P = 0.192), after adjustment with different factors. The reduction in the prevalence of LBW was not different between intervention and control groups (n = 325, 34.0%, 95% CI 31.7-36.4, vs. (n = 127, 34.3%, 95% CI 27.2-41.5, P = 0.932). Significant reductions in risk of stunting (n = 1319 RR 0.85, 95% CI 0.73-0.99, P = 0.041), wasting (n = 1330 RR 0.77, 95% CI 0.65-0.91, P = 0.003), and underweight (n = 1295 RR 0.77, 95% CI 0.69-0.87, P < 0.001) were observed in infants at 6months of age in the intervention as compared to the control group. However, no difference was noted on reduction in the risk of stunting among infants at 6months of age in the intervention and control group (n = 1318 RR 0.91, 95% CI 0.78-1.07, P = 0.253) after adjustment. A significant reduction in anemia was noted (n = 1328 RR 0.94, 95% CI 0.91-0.98, P = 0.002) in infants at 6months of age in the intervention as compared to the control group in adjusted analysis. Provision of WSB + during pregnancy and the first 6months of lactation is effective in reducing the risk of under nutrition and anemia in infants at 6months of age. This study can potentially guide the government and donor agencies in investing in nutritional programmes, especially for pregnant and lactating women living in vulnerable settings.

Association between maternal HIV infection and birthweight in a tertiary hospital in southern Ethiopia: retrospective cohort study

BackgroundHuman Immunodeficiency Virus (HIV) infection and low birth weight (LBW) continue to be significant public health concerns in many low-income countries including Ethiopia. Yet the effect of maternal HIV infection on birth weight has not been thoroughly explored and the existing studies reported opposing findings. We examined the association between maternal HIV infection and LBW in a tertiary hospital in Southern Ethiopia.MethodsA retrospective cohort study was conducted based on the medical records of 277 HIV-negative and 252 HIV-positive mothers who gave singleton live birth between September 2014 to August 2017 in Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia. The recodes were identified using systematic sampling approach and relevant information were extracted by using pretested extraction form. Multivariable binary logit model was fitted to examine the relationship between the exposure and outcome while adjusting for potential confounders. Adjusted odds ratio (AOR) and 95% confidence intervals (CI) is used for summarizing the findings of the analysis.ResultsThe mean (± standard deviation) birth weight of infants born to HIV-negative women (3.1 ± 0.7 kg) was significantly higher than those born to HIV-positive counterparts (3.0 ± 0.6 kg) (p = 0.020). The prevalence of LBW was also significantly higher in the HIV-exposed group (22.2%) than the non-exposed group (13.7%) (p = 0.011). In the logit model adjusted for multiple covariates, HIV-positive women had four times increased odds than HIV-negative women to give birth to LBW infant(AOR = 4.03, 95% CI: 2.01–8.06). Other significant predictors of LBW were rural place of residence (AOR = 2.04, 95% CI: 1.16–3.60), prenatal anemia (AOR = 3.17, 95% CI: 1.71–5.90), chronic hypertension (AOR = 3.68, 95% CI: 1.10–12.46) and preeclampsia (AOR = 6.80, 95% CI: 3.00–15.38).ConclusionMaternal HIV infection is associated with increased odds of LBW. HIV prevention activities are also likely to contribute for the reduction of LBW.

Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Almost two billion people are deficient in key vitamins and minerals, mostly women and children in low- and middle-income countries (LMICs). Deficiencies worsen during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child, but could be mitigated by interventions like micronutrient supplementation. To our knowledge, this is the first systematic review that aimed to compile evidence from both efficacy and effectiveness trials, evaluating different supplementation interventions on maternal, birth, child health, and developmental outcomes. We evaluated randomized controlled trials and quasi-experimental studies published since 1995 in peer-reviewed and grey literature that assessed the effects of calcium, vitamin A, iron, vitamin D, and zinc supplementation compared to placebo/no treatment; iron-folic (IFA) supplementation compared to folic acid only; multiple micronutrient (MMN) supplementation compared to IFA; and lipid-based nutrient supplementation (LNS) compared to MMN supplementation. Seventy-two studies, which collectively involved 314 papers (451,723 women), were included. Meta-analyses showed improvement in several key birth outcomes, such as preterm birth, small-for-gestational age (SGA) and low birthweight with MMN supplementation, compared to IFA. MMN also improved child outcomes, including diarrhea incidence and retinol concentration, which are findings not previously reported. Across all comparisons, micronutrient supplementation had little to no effect on mortality (maternal, neonatal, perinatal, and infant) outcomes, which is consistent with other systematic reviews. IFA supplementation showed notable improvement in maternal anemia and the reduction in low birthweight, whereas LNS supplementation had no apparent effect on outcomes; further research that compares LNS and MMN supplementation could help understand differences with these commodities. For single micronutrient supplementation, improvements were noted in only a few outcomes, mainly pre-eclampsia/eclampsia (calcium), maternal anemia (iron), preterm births (vitamin D), and maternal serum zinc concentration (zinc). These findings highlight that micronutrient-specific supplementation should be tailored to specific groups or needs for maximum benefit. In addition, they further contribute to the ongoing discourse of choosing antenatal MMN over IFA as the standard of care in LMICs.

Effect of Plasmodium falciparum sulfadoxine-pyrimethamine resistance on the effectiveness of intermittent preventive therapy for malaria in pregnancy in Africa: a systematic review and meta-analysis

Resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine threatens the antimalarial effectiveness of intermittent preventive treatment during pregnancy (IPTp) in sub-Saharan Africa. We aimed to assess the associations between markers of sulfadoxine-pyrimethamine resistance in P falciparum and the effectiveness of sulfadoxine-pyrimethamine IPTp for malaria-associated outcomes. For this systematic review and meta-analysis, we searched databases (from Jan 1, 1990 to March 1, 2018) for clinical studies (aggregated data) or surveys (individual participant data) that reported data on low birthweight (primary outcome) and malaria by sulfadoxine-pyrimethamine IPTp dose, and for studies that reported on molecular markers of sulfadoxine-pyrimethamine resistance. Studies that involved only HIV-infected women or combined interventions were excluded. We did a random-effects meta-analysis (clinical studies) or multivariate log-binomial regression (surveys) to obtain summarised dose-response data (relative risk reduction [RRR]) and multivariate meta-regression to explore the modifying effects of sulfadoxine-pyrimethamine resistance (as indicated by Ala437Gly, Lys540Glu, and Ala581Gly substitutions in the dhps gene). This study is registered with PROSPERO, number 42016035540. Of 1097 records screened, 57 studies were included in the aggregated-data meta-analysis (including 59 457 births). The RRR for low birthweight declined with increasing prevalence of dhps Lys540Glu (ptrend=0·0060) but not Ala437Gly (ptrend=0·35). The RRR was 7% (95% CI 0 to 13) in areas of high resistance to sulfadoxine-pyrimethamine (Lys540Glu ≥90% in east and southern Africa; n=11), 21% (14 to 29) in moderate-resistance areas (Ala437Gly ≥90% [central and west Africa], or Lys540Glu ≥30% to <90% [east and southern Africa]; n=16), and 27% (21 to 33) in low-resistance areas (Ala437Gly <90% [central and west Africa], or Lys540Glu <30% [east and southern Africa]; n=30; ptrend=0·0054 [univariate], I2=69·5%). The overall RRR in all resistance strata was 21% (17 to 25). In the analysis of individual participant data from 13 surveys (42 394 births), sulfadoxine-pyrimethamine IPTp was associated with reduced prevalence of low birthweight in areas with a Lys540Glu prevalence of more than 90% and Ala581Gly prevalence of less than 10% (RRR 10% [7 to 12]), but not in those with an Ala581Gly prevalence of 10% or higher (pooled Ala581Gly prevalence 37% [range 29 to 46]; RRR 0·5% [-16 to 14]; 2326 births). The effectiveness of sulfadoxine-pyrimethamine IPTp is reduced in areas with high resistance to sulfadoxine-pyrimethamine among P falciparum parasites, but remains associated with reductions in low birthweight even in areas where dhps Lys540Glu prevalence exceeds 90% but where the sextuple-mutant parasite (harbouring the additional dhps Ala581Gly mutation) is uncommon. Therapeutic alternatives to sulfadoxine-pyrimethamine IPTp are needed in areas where the prevalence of the sextuple-mutant parasite exceeds 37%. US Centers for Disease Control and Prevention, the Malaria in Pregnancy Consortium (funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine), Worldwide Antimalarial Resistance Network, European and Developing Countries Clinical Trials Partnership.