Maternal health, neonatology and perinatology最新文献

Furosemide is a potent loop diuretic commonly and variably used by neonatologists to improve oxygenation and lung compliance in premature infants. There are several safety concerns with use of furosemide in premature infants, specifically the risk of sensorineural hearing loss (SNHL), and nephrocalcinosis/nephrolithiasis (NC/NL). We conducted a systematic review of all trials and observational studies examining the association between these outcomes with exposure to furosemide in premature infants. We searched MEDLINE, EMBASE, CINAHL, and clinicaltrials.gov. We included studies reporting either SNHL or NC/NL in premature infants (< 37 weeks completed gestational age) who received at least one dose of enteral or intravenous furosemide. Thirty-two studies met full inclusion criteria for the review, including 12 studies examining SNHL and 20 studies examining NC/NL. Only one randomized controlled trial was identified in this review. We found no evidence that furosemide exposure increases the risk of SNHL or NC/NL in premature infants, with varying quality of studies and found the strength of evidence for both outcomes to be low. The most common limitation in these studies was the lack of control for confounding factors. The evidence for the risk of SNHL and NC/NL in premature infants exposed to furosemide is low. Further randomized controlled trials of furosemide in premature infants are urgently needed to adequately assess the risk of SNHL and NC/NL, provide evidence for improved FDA labeling, and promote safer prescribing practices.

Background: Preterm birth alters the normal sequence of lactogenesis. Lactogenesis I may not yet have started when mothers of very preterm infants (≤ 29 weeks gestation) have given birth. Preterm infants are too small or too ill to initiate suckling in the immediate postpartum period thus altering the normal cascade of event for lactogenesis II. With an increasing demand for mother's own milk as a primary source of nutritional support in the care of very small and preterm infants, mothers of these infants are often at risk of expressing inadequate amounts of milk. The use of galactogogues is often considered when mothers of preterm infants are still having challenges in breast milk production. What is not clear in the literature is the role that pregnancy gestation at birth plays in successful response to galactogogues. Our objective for this study was to evaluate the role of pregnancy gestation at birth on a mother's response to the treatment interventions in the EMPOWER trial.

Methods: For this analysis, the study participants are the 90 mothers who participated in the EMPOWER trial and were in the stratified in two gestational age groups, 23^0/7-26^6/7 weeks and 27^0/7-29^6/7 weeks at the time of randomization. The primary outcome measures were the proportion of mothers in each of the gestational age groupings who achieved a 50% increase in breast milk volume on day 14 and day 28 of the study treatment period.

Results: On day 14 of the study treatment, there was no significant difference in the proportion of mothers in the 23-26 weeks gestation group (72.9%) compared to those in the 27-29 weeks gestation group (64.2%), OR 1.51 (95% CI 0.60, 3.78; p = 0.38). Similarly, there was no difference in the proportion of mothers between the two gestational age groupings on day 28 of the study treatment, 70.3% compared to 62.3%, OR 1.43 (95% CI 0.58, 3.51; p = 0.43).

Conclusion: This secondary analysis was able to demonstrate that mothers of very preterm infants, < 30 weeks gestation at birth, were able to respond to the study treatment in a similar fashion regardless of gestation at birth. If non-pharmacologic approaches are unsuccessful, then a 14-day treatment of domperidone may be considered to enhance breast milk production, even in the lowest gestational ages at delivery.

Trial registration: EMPOWER has been registered at www.clinicaltrials.gov (identifier NCT 01512225) on January 10, 2012.

Background: About three in ten young women aged 15-19 have begun childbearing among the Zambian population, with adolescent pregnancy levels as high as 35% in rural areas. In 2009, Luapula reported 32.1% adolescent pregnancies. The study sought to investigate obstetric and perinatal outcomes among adolescents compared to mothers aged 20-24 years delivering at selected health facilities in Kawambwa and Mansa districts of Luapula.

Methods: A retrospective analysis was carried out of all deliveries to mothers aged between 10 and 24 years for the period January 2012 to January 2013. A total of 2795 antenatal and delivery records were reviewed; 1291 adolescent mothers and 1504 mothers aged 20-24 years. Crude and adjusted odds ratios for the association between maternal age and adverse obstetric and perinatal outcomes were obtained using logistic regression models.

Results: The mean age of the adolescent mothers was 17.5 years. Mothers younger than 20 years faced a higher risk for eclampsia, anaemia, haemorrhage, Cephalopelvic disproportion, prolonged labour and caesarean section. After adjustment for potential confounders, the association between maternal age and adverse obstetric and perinatal outcome diminished. Children born to mothers younger than 20 were at increased risk for low birth weight, pre-term delivery, low Apgar score and neonatal death; the risk for asphyxia, however, tended to increase with age.

Conclusion: The findings demonstrate that adolescent pregnancy increases the risk of adverse obstetric and perinatal outcomes. High rates of adolescent pregnancies in Luapula province are likely as a result of the predominantly rural and poor population. Understanding the factors that contribute to the high levels of adolescent pregnancy in the region will be vital in addressing the situation and subsequently reducing the high obstetric and perinatal morbidity and mortality.

Background: Postpartum maternal morbidity is maternal illness that occurs after one hour of expulsion of placenta up to six weeks of childbirth. Though the true burden of this problem is not well known estimates of WHO, UNICEF and UNFPA showed that 1.4 million women experience acute obstetric morbidity annually. Knowledge of magnitude and predicting factors postpartum morbidity is central to understand the extent of the problem and will help as a cornerstone in designing and implementing better preventive strategies.

Objectives: To assess the magnitude and factors associated with postpartum morbidity in public health institutions in Debre Markos town.

Method: Institutional based cross sectional study was conducted in Debre Markos town public health institutions by reviewing delivery charts, delivery records and reporting log books. Total deliveries in each health institution in the previous year were identified and number of records to be included from each institution was determined by probability proportion to size. Systematic sampling technique was employed to select 308 charts for review. Data was collected by trained midwifes using structured checklist; entered by epi info and analyzed using SPSS 20. To present findings descriptive statistics using frequencies, charts and figures were used accordingly. Finally binary and multiple logistic regressions were performed to identify predicting factors.

Results: The magnitude of postpartum morbidity was found to be 101(32.8%). Divorced/widowed women [AOR = 10.920, 95% CI: (2.168, 54.998)], women who didn't have ANC follow up [AOR = 3.710, 95% CI: (1.749, 7.870)], abnormal labour [AOR =3.496, 95% CI: (1.69, 7.22)], women delivered by doctor [AOR =0.111, 95% CI: (0.027, 0.454)] and women who were not attended postpartum visit [AOR =0.088, 95% CI: (0.040, 0.194)] were the factors associated with postpartum maternal morbidity.

Conclusion: Maternal morbidity in Debre Markos health institution was found to be major maternal health issue. Being divorced/widowed, absence of ANC visit, intrapartum abnormalities, delivery attended by skilled professionals and no post-partum visit were important predictors of maternal postpartum morbidity.

Background: To achieve recommended nutrient intakes in preterm infants, the target fortification method of human milk (HM) was proposed as an alternative to standard fortification method. We aimed to compare assumed energy and macronutrient intakes based on standard fortified HM with actual intakes relying on measured composition of human milk (HM), in a cohort of HM-fed very preterm infants.

Methods: This study is a secondary retrospective analysis, in which assumed energy and macronutrient contents of daily pools of own mother's milk (OMM) from 33 mothers and donated HM (DHM) delivered to infants were compared with the measured values using a mid-infrared HM analyzer. A fortification method consisting of modular protein and/or fat supplements added to standard fortified HM was used to provide the minimum recommended daily intakes of energy 110 Kcal/kg and protein up to 4.0 g/kg. Assumed nutrient intakes were compared with actual nutrient intakes from full enteral feeding to 35 weeks plus 6 days postmenstrual age, using the Wilcoxon matched-pairs signed ranks test.

Results: The composition of 1181 samples of daily pools of HM were measured. For 90.2% of study days, infants were exclusively fed OMM and in remaining days fed OMM plus DHM. Comparing with reported preterm OMM composition, measured protein concentration was significantly lower, and energy and other macronutrient concentrations were lower only from the second to third postnatal week. Using fortified HM, the actual median daily intakes of energy, protein, and fat were significantly lower (113.3 vs. 120.7 Kcal/kg, 4.45 vs. 4.73 g/kg, and 4.96 vs. 5.35 g/kg, respectively) and the actual protein-to-energy ratio (PER) significantly higher than what was assumed (4.2 vs. 4.0), without differences in carbohydrate intake.

Conclusions: When fortifying the HM, we used conservative target intakes trying not to exceed the osmolarity recommended for infant feeds. Actual energy, protein and fat intakes in OMM were significantly lower than assumed. This resulted in inadequate intake using our fortification method, that did not compensate the suboptimal measured energy and macronutrient contents of OMM delivered. Further studies comparing assumed with the gold standard target fortification are needed to determine safe upper limits of assumed fortification.

Background: Under nutrition is a worldwide public health problem affecting the well-being of millions of pregnant women in the developing world. Only limited research has been conducted on the prevalence and determinants of maternal nutritional status in Ethiopia. Particularly, data on the nutritional status of pregnant women are lacking. The aim of this study was to assess the prevalence and determinants of undernutrition among pregnant women attending antenatal care at the University of Gondar Hospital, Northwest Ethiopia.

Methods: An institution based cross-sectional study was conducted in January and February 2016. Randomly selected 409 pregnant women were included in the study. Nutritional status was estimated using mid-upper-arm circumference. Data on potential determinants of undernutrition were gathered using a structured questionnaire. The blood sample was collected to analyze hemoglobin. The stool sample was collected to identify intestinal parasitic infections. Statistical analysis was done using logistic regression. P-value < 0.05 at 95% confidence interval was considered as statistically significant.

Results: The prevalence of undernutrition among pregnant women was 16.2% (95% CI: 12.4-20.1%). Using a logistic regression model, factors significantly associated with the undernutrition were living in rural areas (AOR = 2.26), low educational status [no formal education (AOR = 2.91), primary education (AOR = 2.69)], history of too many births (AOR = 2.55), anemia (AOR = 2.01), and intestinal parasitic infection (AOR = 2.73).

Conclusion: The study findings provide evidence for the public health significance of under nutrition among pregnant women in the study area. The problem must be combated through rural livelihood promotion, socioeconomic empowerment of women, sustained nutrition education and expansion of family-planning services in the area.

Background: Unintended pregnancies increase levels of stress, adoption of risky behaviours and impact on women's general quality of life. In Ghana, in spite of the paucity of literature on unintended pregnancies, the phenomenon is high especially among women in the early years of their reproductive health. This study therefore sought to investigate the prevalence and correlates of unintended pregnancies in Ghana.

Methods: This study made use of data from the 2014 Ghana Demographic and Health Survey. Descriptive statistics were conducted whereby prevalence of unintended pregnancy was presented in proportions. This was followed by binary logistic regression to investigate correlates associated with unintended pregnancy.

Results: Descriptively, unintended pregnancies were high among women aged 15-19 years (69.4%), unmarried women (45.1%) and non-working women (40.0%). Factors found to be associated with the phenomenon were age, parity and level of education. The binary logistic regression revealed that women in middle wealth category were 1.42 times more probable of having unintended pregnancy than poor women whilst rich women were less likely to experience unintended pregnancy [OR = 0.89, CI = 0.35-0.79] as compared to poor women. Again, urban women were more likely to experience unintended pregnancies as compared rural women [OR = 1.39, CI = 0.86-1.95].

Conclusion: The study has indicated that specific interventions must be targeted at different categories of women. The Reproductive and Child Health unit of the Ghana Health Service ought to collaborate with non-governmental organisations to intensify access to well-tailored family planning services among adolescents and young women, women out of marriage and the non-working category.

Background: Low birth weight (LBW) is a leading risk factor for infant morbidity and mortality in the United States. There are large disparities in the prevalence of LBW by race and ethnicity, especially between African American and White women. Despite extensive research, the practice of clinical and public health, and policies devoted to reducing the number of LBW infants, the prevalence of LBW has remained unacceptably and consistently high. There have been few detailed studies identifying the factors associated with LBW in California, which is home to a highly diverse population. The aim of this study is to investigate recent trends in the prevalence of LBW infants (measured as a percentage) and to identify risk factors and disparities associated with LBW in California.

Methods: A retrospective cohort study included data on 5,267,519 births recorded in the California Birth Statistical Master Files for the period 2005-2014. These data included maternal characteristics, health behaviors, information on health insurance, prenatal care use, and parity. Logistic regression models identified significant risk factors associated with LBW. Using gestational age based on obstetric estimates (OA), small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) infants were identified for the periods 2007-2014.

Results: The number of LBW infants declined, from 37,603 in 2005 to 33,447 in 2014. However, the prevalence of LBW did not change significantly (6.9% in 2005 to 6.7% in 2014). The mean maternal age at first delivery increased from 25.7 years in 2005 to 27.2 years in 2014. The adjusted odds ratio showed that women aged 40 to 54 years were twice as likely to have an LBW infant as women in the 20 to 24 age group. African American women had a persistent 2.4-fold greater prevalence of having an LBW infant compared with white women. Maternal age was a significant risk factor for LBW regardless of maternal race and ethnicity or education level. During the period 2017-2014, 5.4% of the singleton births at 23-41 weeks based on OE of gestational age were SGA infants (preterm SGA + term SGA). While all the preterm SGA infants were LBW, both preterm AGA and term SGA infants had a higher prevalence of LBW.

Conclusions: In California, during the 10 years from 2005 to 2014, there was no significant decline in the prevalence of LBW. However, maternal age was a significant risk factor for LBW regardless of maternal race and ethnicity or education level. Therefore, there may be opportunities to reduce the prevalence of LBW by reducing disparities and improving birth outcomes for women of advanced maternal age.

Background: The International Safe Motherhood initiative provides a focus for programmes and research to improve maternal health in low - income countries. Antenatal care is one of the key pillars of the initiative. This study sought to examine the association between background characteristics and choice of skilled providers of antenatal care services in Ghana.

Methods: The study used data from the six rounds of the Ghana Demographic and Health Survey (GDHS). Binary logistic regression models were applied to analyse the data.

Results: Results show that the proportion of women who received antenatal care (ANC) services from skilled providers improved over the period. Also, women with secondary education (OR = 1.42, CI = 1.07-1.88), richest wealth status (OR = 5.10, CI = 2.28-11.85) were more likely to utilise antenatal care services from skilled providers. Whereas women from rural areas (OR = 0.55, CI = 0.41-0.74), with four births or more (OR = 0.55, CI = 0.36-0.85) and from the northern ethnic group were less likely to utilise antenatal care services from skilled providers.

Conclusion: Choice of skilled providers of antenatal care services were predicted by some predisposing factors including education, ethnicity, and ecological zone. Also enabling factors such as wealth status, residence and the need for care factor, parity predicted choice of skilled providers of antenatal care services. Women with secondary or higher education, those within richer and richest wealth status, those from forest zone are more likely to utilise the services of skilled providers during their antenatal care visits. Whereas women from rural areas, those with four births or more and those with the northern ethnic group were more likely to utilise ANC service from unskilled providers. The Ghana Health Service and Ministry of Health should encourage women in rural areas to utilise antenatal care services from skilled providers through social and behaviour change communication campaigns.

Background: Delayed cord clamping (DCC) results in decreased iron deficiency in infancy. The American College of Obstetrics and Gynecology has called for research on the optimal time to clamp the cord during cesarean deliveries (CD). Our objective was to conduct a pilot trial examining the safety of delayed cord clamping (DCC) for maternal-infant dyads during elective cesarean delivery (CD).

Methods: We enrolled 39 dyads [23 at 90 s, 16 at 120 s; (DCC Pilot)] between 10/2013 and 9/2014. We abstracted data from the electronic medical record (EMR) for historical controls (HC) birthing between 1/2012-6/2013 for whom DCC was not performed (n = 112).

Results: Available data for 37 mothers and 30 infants compared to HC revealed 174 (95% CI: 61-286) mL lower mean estimated maternal blood loss [(EBL) mean (SD) mL]: DCC Pilot 691(218) vs. HC 864(442), p = 0.003 and lower incidence of maternal transfusions, DCC Pilot 2.7% vs. HC 18.8%, p = 0.016. There was no significant between group difference between DCC Pilot and HC in other a priori definitions of excess maternal blood loss: a) EBL > 800 ml, 21.6% vs. 38.8%, p = 0.07 or b) post-op hgb/pre-op hgb < 80%, 16.7% vs. 20.6%, p = 0.81. There were also no statistically significant between group differences in rates of NICU admission DCC Pilot 8.1% vs. HC 7.1%, p = 1.0., but there was a higher rate of newborn cold stress or hypothermia ≤36.2 °C in study subjects, DCC Pilot 27.0% vs. HC 11.9%, p = 0.038.Prevalence of newborn anemia was decreased [DCC pilot 3.3% (1 of 30) vs. HC 40.0% (4 of 10 infants with data), p = 0.012. No infants were polycythemic.

Conclusions: These pilot data suggest cord clamping can be delayed to 120 s during elective CD without increased risk of excessive maternal blood loss. More aggressive prevention of infant heat loss may be warranted. A randomized trial to evaluate long-term maternal and infant outcomes is indicated.

Trial registration: Clinical trials.gov, NCT02229162; registered: 1 September, 2014.