WorldWideScience

Sample records for adverse birth outcomes

  1. RACIAL RESIDENTIAL SEGREGATION AND ADVERSE BIRTH OUTCOMES

    Science.gov (United States)

    INTRODUCTION. The disparity between black and white women's adverse birth outcomes has been subject to much investigation, yet the factors underlying its persistence remain elusive, which has encouraged research on neighborhood-level influences, including racial residential segr...

  2. Perfluorinated compounds in umbilical cord blood and adverse birth outcomes.

    Directory of Open Access Journals (Sweden)

    Mei-Huei Chen

    Full Text Available BACKGROUND: Previous animal studies have shown that perfluorinated compounds (PFCs have adverse impacts on birth outcomes, but the results have been inconclusive in humans. We investigated associations between prenatal exposure to perfluorooctanoic acid (PFOA, perfluorooctyl sulfonate (PFOS, perfluorononanoic acid (PFNA, and perfluoroundecanoic acid (PFUA and birth outcomes. METHODS: In total, 429 mother-infant pairs were recruited from the Taiwan Birth Panel Study (TBPS. Demographic data were obtained by interviewing mothers using a structured questionnaire and birth outcomes were extracted from medical records. Cord blood was collected for PFOA, PFOS, PFNA, and PFUA analysis by ultra-high-performance liquid chromatography/tandem mass spectrometry. RESULTS: The geometric mean (standard deviation levels of PFOA, PFOS, PFNA, and PFUA in cord blood plasma were 1.84 (2.23, 5.94 (1.95, 2.36(4.74, and 10.26 (3.07 ng/mL, respectively. Only PFOS levels were found to be inversely associated with gestational age, birth weight, and head circumference [per ln unit: adjusted β (95% confidence interval, CI = -0.37 (-0.60, -0.13 wks, -110.2 (-176.0, -44.5 gm and -0.25 (-0.46, -0.05 cm]. Additionally, the odds ratio of preterm birth, low birth weight, and small for gestational age increased with PFOS exposure [per ln unit: adjusted odds ratio (OR (95%CI = 2.45 (1.47, 4.08, 2.61(0.85, 8.03 and 2.27 (1.25, 4.15]. When PFOS levels were divided into quartiles, a dose-response relation was observed. However, PFOA, PFNA, and PFUA were not observed to have any convincing impact on birth outcomes. CONCLUSIONS: An adverse dose-dependent association was observed between prenatal PFOS exposure and birth outcomes. However, no associations were found for the other examined PFCs.

  3. Maternal language and adverse birth outcomes in a statewide analysis.

    Science.gov (United States)

    Sentell, Tetine; Chang, Ann; Ahn, Hyeong Jun; Miyamura, Jill

    2016-01-01

    Limited English proficiency is associated with disparities across diverse health outcomes. However, evidence regarding adverse birth outcomes across languages is limited, particularly among U.S. Asian and Pacific Islander populations. The study goal was to consider the relationship of maternal language to birth outcomes using statewide hospitalization data. Detailed discharge data from Hawaii childbirth hospitalizations from 2012 (n = 11,419) were compared by maternal language (English language or not) for adverse outcomes using descriptive and multivariable log-binomial regression models, controlling for race/ethnicity, age group, and payer. Ten percent of mothers spoke a language other than English; 93% of these spoke an Asian or Pacific Islander language. In multivariable models, compared to English speakers, non-English speakers had significantly higher risk (adjusted relative risk [ARR]: 2.02; 95% confidence interval [CI]: 1.34-3.04) of obstetric trauma in vaginal deliveries without instrumentation. Some significant variation was seen by language for other birth outcomes, including an increased rate of primary Caesarean sections and vaginal births after Caesarean, among non-English speakers. Non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries.

  4. Psychosocial job strain and risk of adverse birth outcomes

    DEFF Research Database (Denmark)

    Larsen, Ann Dyreborg; Hannerz, Harald; Juhl, Mette;

    2013-01-01

    A number of studies examined the effects of prenatal stress on birth outcomes with diverging and inconclusive results. We aimed to examine if working with high job strain during pregnancy measured in week 16 was associated with risk of giving birth to a child born preterm or small/large for gesta......A number of studies examined the effects of prenatal stress on birth outcomes with diverging and inconclusive results. We aimed to examine if working with high job strain during pregnancy measured in week 16 was associated with risk of giving birth to a child born preterm or small...

  5. Risk Assessment of Adverse Birth Outcomes in Relation to Maternal Age.

    Directory of Open Access Journals (Sweden)

    Yi-Hao Weng

    Full Text Available Although a number of studies have investigated correlations of maternal age with birth outcomes, an extensive assessment using age as a continuous variable is lacking. In the current study, we estimated age-specific risks of adverse birth outcomes in childbearing women.National population-based data containing maternal and neonatal information were derived from the Health Promotion Administration, Taiwan. A composite adverse birth outcome was defined as at least anyone of stillbirth, preterm birth, low birth weight, macrosomia, neonatal death, congenital anomaly, and small for gestational age (SGA. Singletons were further analyzed for outcomes of live birth in relation to each year of maternal age. A log-binomial model was used to adjust for possible confounders of maternal and neonatal factors.In total, 2,123,751 births between 2001 and 2010 were utilized in the analysis. The risk of a composite adverse birth outcome was significantly higher at extreme maternal ages. In specific, risks of stillbirth, neonatal death, preterm birth, congenital anomaly, and low birth weight were higher at the extremes of maternal age. Furthermore, risk of macrosomia rose proportionally with an increasing maternal age. In contrast, risk of SGA declined proportionally with an increasing maternal age. The log-binomial model showed greater risks at the maternal ages of 30 years for a composite adverse birth outcome.Infants born to teenagers and women at advanced age possess greater risks for stillbirth, preterm birth, neonatal death, congenital anomaly, and low birth weight. Pregnancies at advanced age carry an additional risk for macrosomia, while teenage pregnancies carry an additional risk for SGA. The data suggest that the optimal maternal ages to minimize adverse birth outcomes are 26∼30 years.

  6. Pathways of neighbourhood-level socio-economic determinants of adverse birth outcomes

    OpenAIRE

    Meng, Gang; Thompson, Mary E.; Hall, G Brent

    2013-01-01

    Background Although socio-economic factors have been identified as one of the most important groups of neighbourhood-level risks affecting birth outcomes, uncertainties still exist concerning the pathways through which they are transferred to individual risk factors. This poses a challenge for setting priorities and developing appropriate community-oriented public health interventions and planning guidelines to reduce the level of adverse birth outcomes. Method This study examines potential d...

  7. Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births

    Directory of Open Access Journals (Sweden)

    Núbia Karla O. Almeida

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVES: To investigate the risk of adverse perinatal outcomes in women aged ≥41 years relatively to those aged 21-34. METHODS: Approximately 8.5 million records of singleton births in Brazilian hospitals in the period 2004-2009 were investigated. Odds ratios were estimated for preterm and post-term births, for low Apgar scores at 1 min and at 5 min, for asphyxia, for low birth weight, and for macrosomia. RESULTS: For pregnant women ≥41, increased risks were identified for preterm births, for post-term births (except for primiparous women with schooling ≥12 years, and for low birth weight. When comparing older vs. younger women, higher educational levels ensure similar risks of low Apgar score at 1 min (for primiparous mothers and term births, of low Apgar score at 5 min (for term births, of macrosomia (for non-primiparous women, and of asphyxia. CONCLUSION: As a rule, older mothers are at higher risk of adverse perinatal outcomes, which, however, may be mitigated or eliminated, depending on gestational age, parity, and, especially, on the education level of the pregnant woman.

  8. Violent crime exposure classification and adverse birth outcomes: a geographically-defined cohort study

    Directory of Open Access Journals (Sweden)

    Herring Amy

    2006-05-01

    Full Text Available Abstract Background Area-level socioeconomic disparities have long been associated with adverse pregnancy outcomes. Crime is an important element of the neighborhood environment inadequately investigated in the reproductive and public health literature. When crime has been used in research, it has been variably defined, resulting in non-comparable associations across studies. Methods Using geocoded linked birth record, crime and census data in multilevel models, this paper explored the relevance of four spatial violent crime exposures: two proximal violent crime categorizations (count of violent crime within a one-half mile radius of maternal residence and distance from maternal residence to nearest violent crime and two area-level crime categorizations (count of violent crimes within a block group and block group rate of violent crimes for adverse birth events among women in living in the city of Raleigh NC crime report area in 1999–2001. Models were adjusted for maternal age and education and area-level deprivation. Results In black and white non-Hispanic race-stratified models, crime characterized as a proximal exposure was not able to distinguish between women experiencing adverse and women experiencing normal birth outcomes. Violent crime characterized as a neighborhood attribute was positively associated with preterm birth and low birth weight among non-Hispanic white and black women. No statistically significant interaction between area-deprivation and violent crime category was observed. Conclusion Crime is variably categorized in the literature, with little rationale provided for crime type or categorization employed. This research represents the first time multiple crime categorizations have been directly compared in association with health outcomes. Finding an effect of area-level violent crime suggests crime may best be characterized as a neighborhood attribute with important implication for adverse birth outcomes.

  9. Acculturation and Adverse Birth Outcomes in a Predominantly Puerto Rican Population.

    Science.gov (United States)

    Barcelona de Mendoza, Veronica; Harville, Emily; Theall, Katherine; Buekens, Pierre; Chasan-Taber, Lisa

    2016-06-01

    Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominantly Puerto Rican population. Methods We conducted a secondary analysis of Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011. A convenience sample of pregnant Latina women were recruited from a tertiary care hospital in Massachusetts. Acculturation was measured in early pregnancy; directly via the Psychological Acculturation Scale, and via proxies of language preference and generation in the United States. Birth outcomes (gestational age and birthweight) were abstracted from medical records (n = 1362). Results After adjustment, psychological acculturation, language preference, and generation was not associated with odds of preterm birth. However, every unit increase in psychological acculturation score was associated with an increase in gestational age of 0.22 weeks (SE = 0.1, p = 0.04) among all births. Women who preferred to speak Spanish (β = -0.39, SE = 0.2, p = 0.02) and who were first generation in the US (β = -0.33, SE = 0.1, p = 0.02) had significantly lower gestational ages than women who preferred English or who were later generation, respectively. Similarly, women who were first generation had babies who weighed 76.11 g less (SE = 35.2, p = 0.03) than women who were later generation. Discussion We observed a small, but statistically significant adverse impact of low acculturation on gestational age and birthweight in this predominantly Puerto Rican population. PMID:26694041

  10. Ambient air pollution and adverse birth outcomes: a natural experiment study

    OpenAIRE

    Huang, Cheng; Nichols, Catherine; Liu, Yang; Zhang, Yunping; Liu, Xiaohong; Gao, Suhong; Li, Zhiwen; Ren, Aiguo

    2015-01-01

    Background Radical regulations to improve air quality, including traffic control, were implemented prior to and during the 2008 Beijing Olympic Games. Consequently, ambient concentrations of nitrogen dioxide (NO2) and particular matter 10 micrometers or less (PM10), were reduced in a distinct and short window of time, which presented a natural experiment for testing the relationships between maternal exposure to PM10 and NO2 during pregnancy and adverse birth outcomes. Methods We estimated th...

  11. Birth malformations and other adverse perinatal outcomes in four U.S. Wheat-producing states.

    OpenAIRE

    Schreinemachers, Dina M.

    2003-01-01

    Chlorophenoxy herbicides are widely used in the United States and Western Europe for broadleaf weed control in grain farming and park maintenance. Most of the spring and durum wheat produced in the United States is grown in Minnesota, Montana, North Dakota, and South Dakota, with more than 85% of the acreage treated with chlorophenoxy herbicides such as 2,4-dichlorophenoxyacetic acid (2,4-D) and 4-chloro-2-methylphenoxyacetic acid (MCPA). Rates of adverse birth outcomes in rural, agricultural...

  12. Associations of meteorology with adverse pregnancy outcomes: a systematic review of preeclampsia, preterm birth and birth weight.

    Science.gov (United States)

    Beltran, Alyssa J; Wu, Jun; Laurent, Olivier

    2013-12-20

    The relationships between meteorology and pregnancy outcomes are not well known. This article reviews available evidence on the relationships between seasonality or meteorology and three major pregnancy outcomes: the hypertensive disorders of pregnancy (including preeclampsia, eclampsia and gestational hypertension), gestational length and birth weight. In total 35, 28 and 27 studies were identified for each of these outcomes. The risks of preeclampsia appear higher for women with conception during the warmest months, and delivery in the coldest months of the year. Delivery in the coldest months is also associated with a higher eclampsia risk. Patterns of decreased gestational lengths have been observed for births in winter, as well as summer months. Most analytical studies also report decreases in gestational lengths associated with heat. Birth weights are lower for deliveries occurring in winter and in summer months. Only a limited number of studies have investigated the effects of barometric pressure on gestational length or the effects of temperature and sunshine exposure on birth weight, but these questions appear worth investigating further. Available results should encourage further etiological research aiming at enhancing our understanding of the relationships between meteorology and adverse pregnancy outcomes, ideally via harmonized multicentric studies.

  13. Live birth and adverse birth outcomes in women with ulcerative colitis and Crohn's disease receiving assisted reproduction

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz; Larsen, P V; Fedder, J;

    2016-01-01

    OBJECTIVE: To examine the chance of live births and adverse birth outcomes in women with ulcerative colitis (UC) and Crohn's disease (CD) compared with women without inflammatory bowel disease (IBD) who have undergone assisted reproductive technology (ART) treatments. METHODS: This was a nationwide...... cohort study based on Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 2013. The cohorts comprised 1360 ART treatments in 432 women with UC, 554 ART treatments in 182 women with CD and 148 540 treatments in 52 489 women without IBD. Our primary outcome.......92), but not significantly reduced in the full model of ART treatments in women with CD (OR=0.77, 95% CI 0.52 to 1.14). Surgery for CD before ART treatment significantly reduced the chance of live birth for each embryo transfer (OR=0.51, 95% CI 0.29 to 0.91). In children conceived through ART treatment by women with UC...

  14. Psychoneuroimmunology in pregnancy: immune pathways linking stress with maternal health, adverse birth outcomes, and fetal development.

    Science.gov (United States)

    Christian, Lisa M

    2012-01-01

    It is well-established that psychological stress promotes immune dysregulation in nonpregnant humans and animals. Stress promotes inflammation, impairs antibody responses to vaccination, slows wound healing, and suppresses cell-mediated immune function. Importantly, the immune system changes substantially to support healthy pregnancy, with attenuation of inflammatory responses and impairment of cell-mediated immunity. This adaptation is postulated to protect the fetus from rejection by the maternal immune system. Thus, stress-induced immune dysregulation during pregnancy has unique implications for both maternal and fetal health, particularly preterm birth. However, very limited research has examined stress-immune relationships in pregnancy. The application of psychoneuroimmunology research models to the perinatal period holds great promise for elucidating biological pathways by which stress may affect adverse pregnancy outcomes, maternal health, and fetal development.

  15. Associations of prenatal exposure to five chlorophenols with adverse birth outcomes.

    Science.gov (United States)

    Guo, Jianqiu; Wu, Chunhua; Lv, Shenliang; Lu, Dasheng; Feng, Chao; Qi, Xiaojuan; Liang, Weijiu; Chang, Xiuli; Xu, Hao; Wang, Guoquan; Zhou, Zhijun

    2016-07-01

    Exposures to chlorophenols (CPs) have been linked with adverse health effects on wildlife and humans. This study aimed to evaluate prenatal exposure to five CP compounds using maternal urinary concentrations during pregnancy and the potential associations with birth outcomes of their infants at birth. A total of 1100 mother-newborn pairs were recruited during June 2009 to January 2010 in an agricultural region, China. Urinary concentrations of five CPs from dichlorophenol (DCP) to pentachlorophenol (PCP), namely, 2,5-DCP, 2,4-DCP, 2,4,5-trichlorophenol (2,4,5-TCP), 2,4,6-TCP and PCP, were measured using large-volume-injection gas chromatography-tandem mass spectrometry (LVI-GC-MS-MS), and associations between CP levels and weight, length as well as head circumference at birth were examined. Median urinary creatinine-adjusted concentrations of 2,5-DCP, 2,4-DCP, 2,4,5-TCP, 2,4,6-TCP and PCP were 3.34 μg/g, 1.03 μg/g, < LOD, 1.78 μg/g and 0.39 μg/g creatinine, respectively. We found lower birth weight 30 g [95% confidence interval (CI): -57, -3; p = 0.03] for per SD increase in log10-transformed concentrations of 2,4,6-TCP and lower birth weight 37 g (95% CI: -64, -10; p = 0.04) for PCP, respectively. Similarly, head circumference decrease in associations with creatinine-corrected 2,4,6-TCP and PCP concentrations were also achieved. Considering sex difference, the associations of lower birth weight were only found among male neonates, while head circumference was associated with 2,4-DCP and 2,5-DCP only found among female neonates. This study showed significant negative associations between CPs exposure and reduction in neonatal anthropometric measures. The biological mechanisms concerning CPs exposure on fetal growth deserved further investigations. PMID:27131805

  16. Birth malformations and other adverse perinatal outcomes in four U.S. Wheat-producing states.

    Science.gov (United States)

    Schreinemachers, Dina M

    2003-07-01

    Chlorophenoxy herbicides are widely used in the United States and Western Europe for broadleaf weed control in grain farming and park maintenance. Most of the spring and durum wheat produced in the United States is grown in Minnesota, Montana, North Dakota, and South Dakota, with more than 85% of the acreage treated with chlorophenoxy herbicides such as 2,4-dichlorophenoxyacetic acid (2,4-D) and 4-chloro-2-methylphenoxyacetic acid (MCPA). Rates of adverse birth outcomes in rural, agricultural counties of these states during 1995-1997 were studied by comparing counties with a high proportion of wheat acreage and those with a lower proportion. Information routinely collected and made available by federal agencies was used for this ecologic study. Significant increases in birth malformations were observed for the circulatory/respiratory category for combined sexes [odds ratio (OR) = 1.65; 95% confidence interval (CI), 1.07-2.55]. A stronger effect was observed for the subcategory, which excluded heart malformations (OR = 2.03; 95% CI, 1.14-3.59). In addition, infants conceived during April-June--the time of herbicide application--had an increased chance of being diagnosed with circulatory/respiratory (excluding heart) malformations compared with births conceived during other months of the year (OR = 1.75; 95% CI, 1.09-2.80). Musculoskeletal/integumental anomalies increased for combined sexes in the high-wheat counties (OR = 1.50; 95% CI, 1.06-2.12). Infant death from congenital anomalies significantly increased in high-wheat counties for males (OR = 2.66; 95% CI, 1.52-4.65) but not for females (OR = 0.48; 95% CI, 0.20-1.15). These results are especially of concern because of widespread use of chlorophenoxy herbicides. PMID:12842783

  17. A spatial bivariate probit model for correlated binary data with application to adverse birth outcomes.

    Science.gov (United States)

    Neelon, Brian; Anthopolos, Rebecca; Miranda, Marie Lynn

    2014-04-01

    Motivated by a study examining geographic variation in birth outcomes, we develop a spatial bivariate probit model for the joint analysis of preterm birth and low birth weight. The model uses a hierarchical structure to incorporate individual and areal-level information, as well as spatially dependent random effects for each spatial unit. Because rates of preterm birth and low birth weight are likely to be correlated within geographic regions, we model the spatial random effects via a bivariate conditionally autoregressive prior, which induces regional dependence between the outcomes and provides spatial smoothing and sharing of information across neighboring areas. Under this general framework, one can obtain region-specific joint, conditional, and marginal inferences of interest. We adopt a Bayesian modeling approach and develop a practical Markov chain Monte Carlo computational algorithm that relies primarily on easily sampled Gibbs steps. We illustrate the model using data from the 2007-2008 North Carolina Detailed Birth Record. PMID:22599322

  18. The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women.

    Science.gov (United States)

    Berger, Katherine E; Masterson, James; Mascardo, Joy; Grapa, Jayvee; Appanaitis, Inger; Temengil, Everlynn; Watson, Berry Moon; Cash, Haley L

    2016-08-01

    The small Pacific Island nation of Palau has alarmingly high rates of betel nut with tobacco use and obesity among the entire population including pregnant women. This study aimed to determine the effects of betel nut with tobacco use and pre-pregnancy obesity on adverse birth outcomes. This study used retrospective cohort data on 1171 Palauan women who gave birth in Belau National Hospital in Meyuns, Republic of Palau between 2007 and 2013. The exposures of interest were pre-pregnancy obesity and reported betel nut with tobacco use during pregnancy. The primary outcomes measured were preterm birth and low birth weight among full-term infants. A significantly increased risk for low birth weight among full-term infants was demonstrated among those women who chewed betel nut with tobacco during pregnancy when other known risk factors were controlled for. Additionally, pre-pregnancy obesity was associated with a significantly increased risk for preterm birth when other known risk factors were controlled for. Both betel nut with tobacco use and pre-pregnancy obesity were associated with higher risks for adverse birth outcomes. These findings should be used to drive public health efforts in Palau, as well as in other Pacific Island nations where these studies are currently lacking. PMID:26994610

  19. A Swedish Population-based Study of Adverse Birth Outcomes among Pregnant Women Treated with Buprenorphine or Methadone: Preliminary Findings

    Science.gov (United States)

    Wurst, Keele E.; Zedler, Barbara K.; Joyce, Andrew R.; Sasinowski, Maciek; Murrelle, E. Lenn

    2016-01-01

    BACKGROUND Untreated opioid dependence in pregnant women is associated with adverse birth outcomes. Buprenorphine and methadone are options for opioid agonist medication-assisted treatment during pregnancy. OBJECTIVE The aim of this study was to describe adverse birth outcomes observed with buprenorphine or methadone treatment compared to the general population in Sweden. METHODS Pregnant women and their corresponding births during 2005–2011 were identified in the Swedish Medical Birth Register. Data on stillbirth, neonatal/infant death, mode of delivery, gestational age at birth, Apgar score, growth outcomes, neonatal abstinence syndrome, and congenital malformations were examined. Frequencies were compared using two-sided Fisher’s exact tests. Unadjusted estimates of birth outcomes for women treated with buprenorphine or methadone were compared to the registered general population. RESULTS A total of 746,257 pregnancies among 538,178 unique women resulted in 746,485 live births. Among the 194 women treated with buprenorphine (N = 176) or methadone (N = 52), no stillbirths or neonatal/infant deaths occurred. Neonatal abstinence syndrome developed in 23.3% and 38.5% of infants born to mothers treated with buprenorphine and methadone, respectively. The frequency of the selected adverse birth outcomes assessed in women treated with buprenorphine as compared to the general population was not significantly different. However, a significantly higher frequency of preterm birth and congenital malformations was observed in women treated with methadone as compared to the general population. Compared with the general population, methadone-treated women were significantly older than buprenorphine-treated women, and both treatment groups began prenatal care later, were more likely to smoke cigarettes, and did not cohabitate with the baby’s father. CONCLUSIONS An increased frequency of the selected adverse birth outcomes was not observed with buprenorphine treatment

  20. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Sera Young

    Full Text Available Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART. We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG, and hemoglobin concentration (Hb among 166 women initiating cART in rural Uganda.Prospective cohort.HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis.Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW (19.6%, preterm delivery (17.7%, fetal death (3.9%, stunting (21.1%, small-for-gestational age (15.1%, and head-sparing growth restriction (26%. No infants were HIV-infected. Gaining <0.1 kg/week was associated with LBW, preterm delivery, and a composite adverse obstetric/fetal outcome. Maternal weight at 7 months gestation predicted LBW. For each g/dL higher mean Hb, the odds of small-for-gestational age decreased by 52%.In our cohort of HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained <0.1 kg/week were at increased risk for LBW, preterm delivery, and composite adverse birth outcomes. cART by itself may not be sufficient for decreasing the burden of adverse birth outcomes among HIV-infected women.Clinicaltrials.gov NCT00993031.

  1. Testing the association between psychosocial job strain and adverse birth outcomes - design and methods

    OpenAIRE

    Thulstrup Ane M; Obel Carsten; Hannerz Harald; Larsen Ann D; Bonde Jens P; Hougaard Karin S

    2011-01-01

    Abstract Background A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated with the risk of giving birth to a child born preterm or small for gestational age. Methods and design We will use the Danish National Birth Cohort where 100.000 children are included at bas...

  2. Testing the association between psychosocial job strain and adverse birth outcomes--design and methods

    DEFF Research Database (Denmark)

    Larsen, Ann Dyreborg; Hannerz, Harald; Obel, Carsten;

    2011-01-01

    A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated...

  3. Women with Intellectual Disability at Risk of Adverse Pregnancy and Birth Outcomes

    Science.gov (United States)

    Mcconnell, D.; Mayes, R.; Llewellyn, G.

    2008-01-01

    Background: An increasing number of women with intellectual disability (ID) have children. Cross-sectional, clinical population data suggest that these women face an increased risk of delivering preterm and/or low birthweight babies. The aim of this study was to explore the prevalence of poor pregnancy and birth outcomes in women with ID and/or…

  4. Indoor Exposure and Adverse Birth Outcomes Related to Fetal Growth, Miscarriage and Prematurity—A Systematic Review

    OpenAIRE

    Evridiki Patelarou; Kelly, Frank J.

    2014-01-01

    The purpose of this review was to summarize existing epidemiological evidence of the association between quantitative estimates of indoor air pollution and all-day personal exposure with adverse birth outcomes including fetal growth, prematurity and miscarriage. We carried out a systematic literature search of MEDLINE and EMBASE databases with the aim of summarizing and evaluating the results of peer-reviewed epidemiological studies undertaken in “westernized” countries that have assessed ind...

  5. Testing the association between psychosocial job strain and adverse birth outcomes - design and methods

    Directory of Open Access Journals (Sweden)

    Thulstrup Ane M

    2011-04-01

    Full Text Available Abstract Background A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated with the risk of giving birth to a child born preterm or small for gestational age. Methods and design We will use the Danish National Birth Cohort where 100.000 children are included at baseline. In the present study 49,340 pregnancies will be included. Multinomial logistic regression will be applied to estimate odds ratios for the outcomes: preterm; full term but small for gestational age; full term but large for gestational age, as a function of job-strain (high strain, active and passive versus low strain. In the analysis we control for maternal age, Body Mass Index, parity, exercise, smoking, alcohol use, coffee consumption, type of work (manual versus non-manual, maternal serious disease and parents' heights as well as gestational age at interview. Discussion The prospective nature of the design and the high number of participants strengthen the study. The large statistical power allows for interpretable results regardless of whether or not the hypotheses are confirmed. This is, however, not a controlled study since all kinds of 'natural' interventions takes place throughout pregnancy (e.g. work absence, medical treatment and job-redesign. The analysis will be performed from a public health perspective. From this perspective, we are not primarily interested in the effect of job strain per se but if there is residual effect of job strain after naturally occurring preventive measures have been taken.

  6. Exposure of Particulate Matters PM10 and PM2.5 to Pregnant Ladies during First Trimester and its Impact on Adverse Birth Outcomes in Delhi, India

    Science.gov (United States)

    Kumar, S.; Goyal, P.

    2015-12-01

    The incessant exposure to criteria air pollutants at different level of concentrations is associated with adverse birth outcomes. The present study advocates the importance of the early period of pregnancy (first trimester) for association between growth in term of small gestational age (SGA) and birth weight (BW) with PM2.5 and PM10 for megacity Delhi. The association of PM10 and PM2.5 average concentration, SGA, pre term birth (PTB) and lower birth weight (LBW gestation.

  7. Indoor exposure and adverse birth outcomes related to fetal growth, miscarriage and prematurity-a systematic review.

    Science.gov (United States)

    Patelarou, Evridiki; Kelly, Frank J

    2014-06-01

    The purpose of this review was to summarize existing epidemiological evidence of the association between quantitative estimates of indoor air pollution and all-day personal exposure with adverse birth outcomes including fetal growth, prematurity and miscarriage. We carried out a systematic literature search of MEDLINE and EMBASE databases with the aim of summarizing and evaluating the results of peer-reviewed epidemiological studies undertaken in "westernized" countries that have assessed indoor air pollution and all-day personal exposure with specific quantitative methods. This comprehensive literature search identified 16 independent studies which were deemed relevant for further review and two additional studies were added through searching the reference lists of all included studies. Two reviewers independently and critically appraised all eligible articles using the Critical Appraisal Skills Programme (CASP) tool. Of the 18 selected studies, 14 adopted a prospective cohort design, three were case-controls and one was a retrospective cohort study. In terms of pollutants of interest, seven studies assessed exposure to electro-magnetic fields, four studies assessed exposure to polycyclic aromatic hydrocarbons, four studies assessed PM2.5 exposure and three studies assessed benzene, phthalates and noise exposure respectively. Furthermore, 12 studies examined infant growth as the main birth outcome of interest, six examined spontaneous abortion and three studies assessed gestational age at birth and preterm delivery. This survey demonstrates that there is insufficient research on the possible association of indoor exposure and early life effects and that further research is needed. PMID:24896737

  8. Intervillous macrophage migration inhibitory factor is associated with adverse birth outcomes in a study population in Central India.

    Directory of Open Access Journals (Sweden)

    Puspendra P Singh

    Full Text Available Macrophage migration inhibitory factor (MIF is a pluripotent factor produced by a variety of cells. It plays an important biological role in the regulation of pregnancy and has been shown to influence malaria pathogenesis. In this study, the levels of MIF in the peripheral, cord and placental intervillous blood (IVB plasma collected from women residing in a malaria endemic region of Central India was determined and its association with malaria in pregnancy and birth outcomes was investigated. MIF levels were significantly different in IVB, peripheral, and cord plasma, with IVB plasma having the highest MIF levels and peripheral plasma having the lowest. Placental malaria positive women had significantly higher IVB plasma MIF levels than placental malaria negative women, but this relationship was not seen in peripheral or cord plasma MIF levels. In addition, the odds of stillbirth and low birth weight deliveries for the uppermost placental MIF quartile (irrespective of placental malaria status was significantly higher than that of the lowest placental MIF quartile, supporting the hypothesis that elevated concentrations of placental MIF may be associated with an increased risk of adverse birth outcome.

  9. Residential proximity to traffic and adverse birth outcomes in Los Angeles county, California, 1994-1996.

    OpenAIRE

    Wilhelm, Michelle; Ritz, Beate

    2003-01-01

    We reported previously that increases in ambient air pollution in the Los Angeles basin increased the risk of low weight and premature birth. However, ambient concentrations measured at monitoring stations may not take into account differential exposure to pollutants found in elevated concentrations near heavy-traffic roadways. Therefore, we used an epidemiologic case-control study design to examine whether residential proximity to heavy-traffic roadways influenced the occurrence of low birth...

  10. The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based study

    Directory of Open Access Journals (Sweden)

    Giraud Julie

    2009-07-01

    Full Text Available Abstract Background The association between area characteristics and birth outcomes is modified by race. Whether such associations vary according to social class indicators beyond race has not been assessed. Methods This study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 1999–2003 in the province of Québec, Canada (N = 353,120 births. Areas (N = 143 were defined as administrative local health service delivery districts. Multi-level logistic regression was used to model the association between three area characteristics (median household income, immigrant density and income inequality and the two outcomes preterm birth (PTB and small-for-gestational age (SGA birth. Effect modification by social class indicators was evaluated in analyses stratified according to maternal birthplace and education. Results Relative to the lowest tertile, high median household income was associated with SGA birth among Canadian-born mothers (odds ratio (OR 1.13, 95% confidence interval (CI 1.06, 1.20 and mothers with high school education or less (OR 1.13, 95% CI 1.02, 1.24. Associations between median household income and PTB were weaker. Relative to the highest tertile, low immigrant density was associated with a lower odds of PTB among foreign-born mothers (OR 0.79, 95% CI 0.63, 1.00 but a higher odds of PTB among Canadian-born mothers (OR 1.14, 95% CI 1.07, 1.21. Associations with income inequality were weak or absent. Conclusion The association between area factors and birth outcomes is modified by maternal birthplace and education. Studies have found that race interacts in a similar manner. Public health policies focussed on perinatal health must consider the interaction between individual and area characteristics.

  11. Intervillous Macrophage Migration Inhibitory Factor Is Associated with Adverse Birth Outcomes in a Study Population in Central India

    OpenAIRE

    Singh, Puspendra P.; Lucchi, Naomi W.; Anna Blackstock; Venkatachalam Udhayakumar; Neeru Singh

    2012-01-01

    Macrophage migration inhibitory factor (MIF) is a pluripotent factor produced by a variety of cells. It plays an important biological role in the regulation of pregnancy and has been shown to influence malaria pathogenesis. In this study, the levels of MIF in the peripheral, cord and placental intervillous blood (IVB) plasma collected from women residing in a malaria endemic region of Central India was determined and its association with malaria in pregnancy and birth outcomes was investigate...

  12. Caffeine intake during pregnancy and adverse birth outcomes: a systematic review and dose-response meta-analysis.

    Science.gov (United States)

    Greenwood, Darren C; Thatcher, Natalie J; Ye, Jin; Garrard, Lucy; Keogh, Georgina; King, Laura G; Cade, Janet E

    2014-10-01

    Caffeine is commonly consumed during pregnancy, crosses the placenta, with fetal serum concentrations similar to the mother's, but studies of birth outcome show conflicting findings. We systematically searched Medline and Embase for relevant publications. We conducted meta-analysis of dose-response curves for associations between caffeine intake and spontaneous abortion, stillbirth, preterm delivery, low birth weight and small for gestational age (SGA) infants. Meta-analyses included 60 unique publications from 53 cohort and case-control studies. An increment of 100 g caffeine was associated with a 14 % (95 % CI 10-19 %) increase in risk of spontaneous abortion, 19 % (5-35 %) stillbirth, 2 % (-2 to 6 %) preterm delivery, 7 % (1-12 %) low birth weight, and 10 % (95 % CI 6-14 %) SGA. There was substantial heterogeneity in all models, partly explained by adjustment for smoking and previous obstetric history, but not by prospective assessment of caffeine intake. There was evidence of small-study effects such as publication bias. Greater caffeine intake is associated with an increase in spontaneous abortion, stillbirth, low birth weight, and SGA, but not preterm delivery. There is no identifiable threshold below which the associations are not apparent, but the size of the associations are generally modest within the range of usual intake and are potentially explained by bias in study design or publication. There is therefore insufficient evidence to support further reductions in the maximum recommended intake of caffeine, but maintenance of current recommendations is a wise precaution.

  13. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study

    NARCIS (Netherlands)

    Jonge, A. de; Mesman, J.A.; Mannien, J.; Zwart, J.J.; Dillen, J. van; Roosmalen, J. van

    2013-01-01

    OBJECTIVES: To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. DESIGN: Cohort study u

  14. Adverse birth outcome: a comparative analysis between cesarean section and vaginal delivery at Felegehiwot Referral Hospital, Northwest Ethiopia: a retrospective record review

    Directory of Open Access Journals (Sweden)

    Abebe Eyowas F

    2016-07-01

    Full Text Available Fantu Abebe Eyowas,1 Ashebir Kidane Negasi,1 Gizachew Eyassu Aynalem,1 Abebaw Gebeyehu Worku2 1International NGO, Strengthening Human Resource for Health, Bahir Dar, 2Institute of Public Health, University of Gondar, Gondar, Ethiopia Introduction: Some studies favor elective cesarean delivery, and other surveys benefit vaginal delivery, while others emphasize that the quality of care during labor, birth, and immediate postpartum period plays a great role than the route of delivery. However, little information is locally available regarding the incidences of adverse birth outcome with respect to the route of delivery. Methods: This study was a retrospective analysis of eligible patient records that included 3,003 pregnant women who had undergone either cesarean or vaginal delivery from July 1, 2012, to June 31, 2013. Pretested questionnaire was used to collect the data. The completeness and consistency of the data were checked, cleaned, and double entered to EPI-INFO 3.5.2 and analyzed with SPSS V20. Independent sample t-test and chi-square test were conducted to compare the outcome of vaginal delivery and cesarean section (CS using index variables. Significance was taken at P<0.05. Results: Among the enrolled women, 760 mothers had CS delivery and the remaining 2,243 mothers delivered vaginally. Children born through CS (mean =6.83, standard deviation =1.31 had a significantly lower first-minute Apgar score than those in the vaginal delivery group (mean =7.19, standard deviation =1.18, P=0.001. Similarly, the observed respiratory distress syndrome (c2=0.09, P=0.793 and neonatal transfer rate to neonatal intensive care unit (c2=0.086, P=0.766 were more in neonates delivered by CS than those in the vaginally delivered group. Besides, the observed neonatal death (c2=0.675, P=0.411 and maternal death (c2= 8.878, P=0.003 were higher among CS deliveries compared with vaginal deliveries. Conclusion: Neonatal and maternal morbidity and mortality appear

  15. Risk of infection and adverse outcomes among pregnant working women in selected occupational groups: A study in the Danish National Birth Cohort

    Directory of Open Access Journals (Sweden)

    Llopis-González Agustín

    2010-11-01

    Full Text Available Abstract Background Exposure to infectious pathogens is a frequent occupational hazard for women who work with patients, children, animals or animal products. The purpose of the present study is to investigate if women working in occupations where exposure to infections agents is common have a high risk of infections and adverse pregnancy outcomes. Methods We used data from the Danish National Birth Cohort, a population-based cohort study and studied the risk of Infection and adverse outcomes in pregnant women working with patients, with children, with food products or with animals. The regression analysis were adjusted for the following covariates: maternal age, parity, history of miscarriage, socio-occupational status, pre-pregnancy body mass index, smoking habit, alcohol consumption. Results Pregnant women who worked with patients or children or food products had an excess risk of sick leave during pregnancy for more than three days. Most of negative reproductive outcomes were not increased in these occupations but the prevalence of congenital anomalies (CAs was slightly higher in children of women who worked with patients. The prevalence of small for gestational age infants was higher among women who worked with food products. There was no association between occupation infections during pregnancy and the risk of reproductive failures in the exposed groups. However, the prevalence of CAs was slightly higher among children of women who suffered some infection during pregnancy but the numbers were small. Conclusion Despite preventive strategies, working in specific jobs during pregnancy may impose a higher risk of infections, and working in some of these occupations may impose a slightly higher risk of CAs in their offspring. Most other reproductive failures were not increased in these occupations.

  16. Assessing risk factors for adverse birth outcomes and early childhood respiratory illness: an examination of supplement initiation and participation in Special Supplemental Nutrition Program for Women, Infants and Children during pregnancy

    OpenAIRE

    Alfonso, Vivian

    2015-01-01

    In the United States, rate of preterm birth peaked in 2006 and little progress has been made to date despite ambitious Healthy People 2020 goals. Infants born premature are at higher risk of death and disability, including psychological conditions, learning difficulties and medical disabilities, than term newborns. Additionally, adverse birth outcomes are associated with asthma, the leading cause of chronic childhood illness and disability. According to the ‘Barker hypothesis’, intrauterin...

  17. The first injustice : Socio-economic inequalities in birth outcome

    OpenAIRE

    Gisselmann, Marit

    2007-01-01

    Adverse birth outcomes like preterm birth and infant mortality are unevenly distributed across socio-economic groups. Risks are usually lowest in groups with high socio-economic status and increase with decreasing status. The general aim of this thesis was to contribute to the understanding of the relation between socio-economic status and birth outcomes, focussing on maternal education and class, studying a range of birth outcomes. More specific aims were to investigate the relation between ...

  18. The complement system and adverse pregnancy outcomes.

    Science.gov (United States)

    Regal, Jean F; Gilbert, Jeffrey S; Burwick, Richard M

    2015-09-01

    Adverse pregnancy outcomes significantly contribute to morbidity and mortality for mother and child, with lifelong health consequences for both. The innate and adaptive immune system must be regulated to insure survival of the fetal allograft, and the complement system is no exception. An intact complement system optimizes placental development and function and is essential to maintain host defense and fetal survival. Complement regulation is apparent at the placental interface from early pregnancy with some degree of complement activation occurring normally throughout gestation. However, a number of pregnancy complications including early pregnancy loss, fetal growth restriction, hypertensive disorders of pregnancy and preterm birth are associated with excessive or misdirected complement activation, and are more frequent in women with inherited or acquired complement system disorders or complement gene mutations. Clinical studies employing complement biomarkers in plasma and urine implicate dysregulated complement activation in components of each of the adverse pregnancy outcomes. In addition, mechanistic studies in rat and mouse models of adverse pregnancy outcomes address the complement pathways or activation products of importance and allow critical analysis of the pathophysiology. Targeted complement therapeutics are already in use to control adverse pregnancy outcomes in select situations. A clearer understanding of the role of the complement system in both normal pregnancy and complicated or failed pregnancy will allow a rational approach to future therapeutic strategies for manipulating complement with the goal of mitigating adverse pregnancy outcomes, preserving host defense, and improving long term outcomes for both mother and child.

  19. Reverse Engineering Adverse Outcome Pathways

    Energy Technology Data Exchange (ETDEWEB)

    Perkins, Edward; Chipman, J.K.; Edwards, Stephen; Habib, Tanwir; Falciani, Francesco; Taylor, Ronald C.; Van Aggelen, Graham; Vulpe, Chris; Antczak, Philipp; Loguinov, Alexandre

    2011-01-30

    The toxicological effects of many stressors are mediated through unknown, or poorly characterized, mechanisms of action. We describe the application of reverse engineering complex interaction networks from high dimensional omics data (gene, protein, metabolic, signaling) to characterize adverse outcome pathways (AOPs) for chemicals that disrupt the hypothalamus-pituitary-gonadal endocrine axis in fathead minnows. Gene expression changes in fathead minnow ovaries in response to 7 different chemicals, over different times, doses, and in vivo versus in vitro conditions were captured in a large data set of 868 arrays. We examined potential AOPs of the antiandrogen flutamide using two mutual information theory methods, ARACNE and CLR to infer gene regulatory networks and potential adverse outcome pathways. Representative networks from these studies were used to predict a network path from stressor to adverse outcome as a candidate AOP. The relationship of individual chemicals to an adverse outcome can be determined by following perturbations through the network in response to chemical treatment leading to the nodes associated with the adverse outcome. Identification of candidate pathways allows for formation of testable hypotheses about key biologic processes, biomarkers or alternative endpoints, which could be used to monitor an adverse outcome pathway. Finally, we identify the unique challenges facing the application of this approach in ecotoxicology, and attempt to provide a road map for the utilization of these tools. Key Words: mechanism of action, toxicology, microarray, network inference

  20. Maternal education and adverse birth outcomes among immigrant women to the United States from Eastern Europe: a test of the healthy migrant hypothesis.

    Science.gov (United States)

    Janevic, T; Savitz, D A; Janevic, M

    2011-08-01

    Immigrant women to the U.S. often have more favorable birth outcomes than their native-born counterparts, including lower rates of preterm birth and low birth weight, a phenomenon commonly attributed to a healthy migrant effect. However, this effect varies by ethnicity and country of origin. No previous study has examined birth outcomes among immigrants from the post-Communist countries of Eastern Europe, a group which includes both economic migrants and conflict refugees. Using data on 253,363 singletons births from New York City during 1995-2003 we examined the risk of preterm birth (PTB) (Russia and Ukraine (RU), Poland, and former Yugoslavia Republics (FYR) relative to US-born non-Hispanic whites (NHW). Women in all three Eastern European groups had significantly later entry into prenatal care, were more likely to be Medicaid recipients, and had lower educational attainment than US-born NHW. In binomial regression analyses adjusting for age, education, parity, and pre-pregnancy weight, women from RU and FYR had lower risk of PTB than US-born NHW, whereas women from Poland had similar risk. Lower SGA risk was found among women from Poland and FYR, but not RU. When stratified by education, women with conflict refugees.

  1. Periodontal treatment for preventing adverse pregnancy outcomes

    DEFF Research Database (Denmark)

    Schwendicke, Falk; Karimbux, Nadeem; Allareddy, Veerasathpurush;

    2015-01-01

    .79 [0.57-1.10]) or low birth weight (0.69 [0.43-1.13]). Trial sequential analysis demonstrated that futility was not reached for any of the outcomes. For populations with moderate occurrence (...OBJECTIVES: Periodontal treatment might reduce adverse pregnancy outcomes. The efficacy of periodontal treatment to prevent preterm birth, low birth weight, and perinatal mortality was evaluated using meta-analysis and trial sequential analysis. METHODS: An existing systematic review was updated...... and meta-analyses performed. Risk of bias, heterogeneity, and publication bias were evaluated, and meta-regression performed. Subgroup analysis was used to compare different studies with low and high risk of bias and different populations, i.e., risk groups. Trial sequential analysis was used to assess...

  2. Teen Smoking and Birth Outcomes

    OpenAIRE

    MaryBeth Walker; Erdal Tekin; Sally Wallace

    2007-01-01

    In the U.S. teen mothers are more likely to give birth to low birth weight babies than non-teen mothers. There is also substantial evidence that smoking is a risk factor correlated with low birth weight. Low birth weight is a costly outcome in both the short and long term for parents, children, and society at large. This paper examines the causal link between teen age smoking behavior and low birth weight. We use a variety of empirical techniques including fixed effects and a matching estimat...

  3. Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes.

    Directory of Open Access Journals (Sweden)

    Seung Mi Lee

    Full Text Available BACKGROUND: The objective of this study was to determine whether acute histologic chorioamnionitis is associated with adverse neonatal outcomes in late preterm infants who were born after preterm PROM. METHODOLOGY/PRINCIPAL FINDINGS: The relationship between the presence of acute histologic chorioamnionitis and adverse neonatal outcome was examined in patients with preterm PROM who delivered singleton preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Nonparametric statistics were used for data analysis. The frequency of acute histologic chorioamnionitis was 24% in patients with preterm PROM who delivered preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Newborns born to mothers with histologic chorioamnionitis had significantly higher rates of adverse neonatal outcome (74% vs 51%; p<0.005 than those without histologic chorioamnionitis. This relationship remained significant after adjustment for gestational age at preterm PROM, gestational age at delivery, and exposure to antenatal corticosteroids. CONCLUSIONS/SIGNIFICANCE: The presence of acute histologic chorioamnionitis is associated with adverse neonatal outcome in late preterm infants born to mothers with preterm PROM.

  4. Adverse obstetrical and perinatal outcome in adolescent mothers associated with first birth: a hospital-based case-control study in a tertiary care hospital in North-East India

    Directory of Open Access Journals (Sweden)

    Medhi R

    2016-04-01

    Full Text Available Robin Medhi, Banani Das, Arpana Das, Mansur Ahmed, Sonika Bawri, Suditi Rai Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India Purpose: To analyze the adverse obstetrical and perinatal outcome of adolescent mothers associated with first birth. Patients and methods: This prospective case-control study was conducted in a tertiary care teaching hospital of North-East India between January 2014 and December 2014. All adolescent primigravidae completing 28 weeks of gestation with singleton pregnancy and delivered at our institution were included in the study group. Primigravidae aged between 20 and 25 years were taken as a control group. Mothers having pregnancy complicated with diabetes mellitus, renal disorder, thyroid disorders, and cardiac diseases were excluded from the study. Demographic data, maternal complications like severe anemia, pre-eclampsia, eclampsia, gestational age at delivery, mode of delivery, and postpartum complications were compared. Among fetal complications, low-birth weight, preterm birth, neonatal intensive care unit admission, still birth, and early neonatal death were compared. All the patients were interviewed regarding contraceptive knowledge and its use preceding the pregnancy. Results: Quality antenatal care was received by 80.6% of adolescent mothers. The adolescent mothers had a higher incidence of pre-eclampsia (odds ratio [OR] 2.017 95% confidence interval [CI]: 1.045–3.894, P=0.03, preterm deliveries (OR: 1.655, 95% CI: 1.039–2.636, P=0.03. Among fetal outcomes, the low- birth weight babies (OR: 1.59, 95% CI: 1.016–2.478, low mean birth weight (2,544.4±622.09 g versus 2,701.6±582.51 g, and higher admission to neonatal intensive care unit (OR: 1.957, 95% CI: 1.120–3.417 were significantly associated with adolescent mothers. There was no significant difference found regarding the mode of delivery, still birth, and early neonatal death. Moreover

  5. The association between social economic status during pregnancy and the adverse birth outcomes in Chinese women%妇女孕期社会经济状态与新生儿体重的关系

    Institute of Scientific and Technical Information of China (English)

    卢福泉; 陈鹤; 裴丽君; 郑晓瑛

    2012-01-01

    目的:分析妇女孕期的社会经济状态与不良妊娠结局关系,为筛查可能生育不良体重儿的高风险孕妇提供依据.方法:利用2002年中国居民营养与健康调查数据,根据妊娠结局以及孕妇年龄、社会经济状态、体力活动模式和营养补充情况建立8个研究模型,以多元logistic回归分析4159例乳母样本.结果:低出生体重儿和巨大儿的发生率分别为5.8%和11.4%.通过建立不同模型对比分析发现,生活在中小城市、小学及以下教育程度、低收入、步行出行方式的妇女生育低出生体重儿风险更高;小学及以下教育程度、轻体力活动、自行车或公交车出行、服用碘制剂的妇女生育巨大儿的风险更高.结论:社会经济状态处于劣势的妇女生育异常体重新生儿的风险更高,应有针对性地筛查风险人群.%Objective; To investigate the association of socioeconomic status of pregnant women with the adverse birth outcomes in Chinese women to provide the evidence for the screening of the pregnant women at high risk of adverse birth outcomes. Methods: Based on Chinese Nutrition and Health Survey 2002, a multiple Logistic regression was conducted to examine the associations between the three main series of categorical independent variables ( socioeconomic status, physical activity, and nutrition supplement) and the two dependent variables (low birth weight and macrosomia). Results; The incidences of low birth weight and macrosomia in the studied women were 5.8% and 11.4% , respectively. Pregnant women living in a middle/small town, with lower education, lower income, and with walking as a main way of transportation, had a higher possibility of producing low - birth - weight babies, and those with lower education, lighter intensity of physical activity, and with bike or public transportation as main transportation way, had a higher possibility of producing macrosomia babies. Conclusion; The socioeco

  6. Adverse birth outcome: a comparative analysis between cesarean section and vaginal delivery at Felegehiwot Referral Hospital, Northwest Ethiopia: a retrospective record review

    OpenAIRE

    Abebe Eyowas, Fantu

    2016-01-01

    Fantu Abebe Eyowas,1 Ashebir Kidane Negasi,1 Gizachew Eyassu Aynalem,1 Abebaw Gebeyehu Worku2 1International NGO, Strengthening Human Resource for Health, Bahir Dar, 2Institute of Public Health, University of Gondar, Gondar, Ethiopia Introduction: Some studies favor elective cesarean delivery, and other surveys benefit vaginal delivery, while others emphasize that the quality of care during labor, birth, and immediate postpartum period plays a great role than the route of delivery. However, l...

  7. Availability of Reproductive Health Care Services at Schools and Subsequent Birth Outcomes among Adolescent Mothers

    Science.gov (United States)

    Madkour, Aubrey S.; Xie, Yiqiong; Harville, Emily W.

    2016-01-01

    Background: Adverse birth outcomes are more common among adolescent versus adult mothers, but little is known about school-based services that may improve birth outcomes in this group. Methods: Data from Waves I and IV of the National Longitudinal Study of Adolescent Health were analyzed. Girls and women who gave birth to singleton live infants…

  8. Associations of prenatal exposure to phenols with birth outcomes

    International Nuclear Information System (INIS)

    Many phenols are known to mimic or antagonize hormonal activities and may adversely affect fetal growth. A study of 567 pregnant women was conducted to investigate the relationship between prenatal phenol exposure and birth outcomes, including birth weight, length, and gestational age. We measured the concentrations of bisphenol A, benzophenone-3, 4-n-octylphenol and 4-n-nonylphenol in maternal urine and examine their association with birth outcomes. Categories of urinary benzophenone-3 concentration were associated with decreased gestational age in all infants (p for trend = 0.03). Between middle and low exposure groups, we also found bisphenol A was negatively associated with gestational duration (βadjusted = −0.48 week; 95% confidence interval: −0.91, −0.05). After stratification by gender, we found the consistent results in infant boys with those in all infants, but we did not observe significant association for girls. In conclusion, we found prenatal phenol exposure was sex-specifically related to birth outcomes. -- Highlights: •We examined relationship of prenatal exposure to phenols with birth outcomes. •We determined urinary concentrations of various phenols. •BP-3 and BPA were negatively associated with gestational age. •There was sex-specific association between phenol exposure and birth outcomes. -- Prenatal phenol exposure was sex-specifically related to birth outcomes

  9. Collateral Adverse Outcomes After Lumbar Spine Surgery.

    Science.gov (United States)

    Daniels, Alan H; Gundle, Kenneth; Hart, Robert A

    2016-01-01

    Collateral adverse outcomes are the expected or unavoidable results of a procedure that is performed in a standard manner and typically experienced by the patient. Collateral adverse outcomes do not result from errors, nor are they rare. Collateral adverse outcomes occur as the direct result of a surgical procedure and must be accepted as a trade-off to attain the intended benefits of the surgical procedure. As such, collateral adverse outcomes do not fit into the traditional definition of a complication or adverse event. Examples of collateral adverse outcomes after lumbar spine arthrodesis include lumbar stiffness, postoperative psychological stress, postoperative pain, peri-incisional numbness, paraspinal muscle denervation, and adjacent-level degeneration. Ideally, a comparison of interventions for the treatment of a clinical condition should include information on both the negative consequences (expected and unexpected) and potential benefits of the treatment options. The objective evaluation and reporting of collateral adverse outcomes will provide surgeons with a more complete picture of invasive interventions and, thus, the improved ability to assess alternative treatment options. PMID:27049197

  10. Putative adverse outcome pathways relevant to neurotoxicity

    Science.gov (United States)

    Bal-Price, Anna; Crofton, Kevin M.; Sachana, Magdalini; Shafer, Timothy J.; Behl, Mamta; Forsby, Anna; Hargreaves, Alan; Landesmann, Brigitte; Lein, Pamela J.; Louisse, Jochem; Monnet-Tschudi, Florianne; Paini, Alicia; Rolaki, Alexandra; Schrattenholz, André; Suñol, Cristina; van Thriel, Christoph; Whelan, Maurice; Fritsche, Ellen

    2016-01-01

    The Adverse Outcome Pathway (AOP) framework provides a template that facilitates understanding of complex biological systems and the pathways of toxicity that result in adverse outcomes (AOs). The AOP starts with an molecular initiating event (MIE) in which a chemical interacts with a biological target(s), followed by a sequential series of KEs, which are cellular, anatomical, and/or functional changes in biological processes, that ultimately result in an AO manifest in individual organisms and populations. It has been developed as a tool for a knowledge-based safety assessment that relies on understanding mechanisms of toxicity, rather than simply observing its adverse outcome. A large number of cellular and molecular processes are known to be crucial to proper development and function of the central (CNS) and peripheral nervous systems (PNS). However, there are relatively few examples of well-documented pathways that include causally linked MIEs and KEs that result in adverse outcomes in the CNS or PNS. As a first step in applying the AOP framework to adverse health outcomes associated with exposure to exogenous neurotoxic substances, the EU Reference Laboratory for Alternatives to Animal Testing (EURL ECVAM) organized a workshop (March 2013, Ispra, Italy) to identify potential AOPs relevant to neurotoxic and developmental neurotoxic outcomes. Although the AOPs outlined during the workshop are not fully described, they could serve as a basis for further, more detailed AOP development and evaluation that could be useful to support human health risk assessment in a variety of ways. PMID:25605028

  11. PREVALENCE OF ADVERSE PREGNANCY OUTCOMES: A COMMUNITY BASED LONGITUDINAL STUDY

    Directory of Open Access Journals (Sweden)

    Vidya

    2015-06-01

    Full Text Available BACKGROUND: In most developed countries, pregnancies are planned, complications are few and outcomes are generally favorable for both mother and infant. But in developing countries, adverse pregnancy outcomes are far more frequent due to various reasons. T he most severe adverse outcome of pregnancy is the death of the mother or her offspring. Over the years maternal and child health programmes are striving to improve the health status of pregnant women and neonates. However, the adverse pregnancy outcomes ( M aternal and N eonatal still remain high. OBJECTIVE: To study the prevalence of adverse pregnancy in the study area. METHODOLOGY: A community based longitudinal study was carried out in the 36 villages of Kaiwara from January 2011 to December 2011. All the antenatal mothers were traced through Anganwadi records maintained at different villages. They were contacted at their residence and the questionnaire was administered in their local language. The questionnaire was administered during three different visi ts to collect information regarding socio - demographic details, pregnancy outcomes. The first visit was made before delivery and subsequently second and third visits were made within 7 days and 42 nd day after delivery respectively. Maternal and child protec tion cards were used to validate the collected information. Statistical analysis was performed using SPSS software version 18.0 RESULTS: The present study revealed that, the proportion of low birth weight in the study area was 31.9% (95% CI=25.74 - 38.06, p reterm birth 20.5% (95% CI=15.28 - 25.72, postnatal complications 5% (95% CI=14.819 - 9.181, abortion 2.1% (95% CI=0.25 - 3.95, maternal death 0.4% (95% CI=0.416 - 1.216 and neonatal death 0.4% (95% CI=0.416 - 1.216. CONCLUSION: The present study revealed that the proportion of adverse pregnancy outcomes was in par with the national average.

  12. Relationship between pre-pregnancy BMI and adverse birth outcomes%孕前体质指数与4种不良妊娠结局关系

    Institute of Scientific and Technical Information of China (English)

    楚舟; 陶芳标; 郝加虎; 宫相君; 徐蓉; 孙露; 刘芳

    2012-01-01

    Objective To assess the relationships between pre-pregnancy body mass index(BMI) and the 4 adverse biith outcomes, including small for gestational age (SGA ) , large for gestational age (LOA ) , low birth weight (LBW), and macrosomia. Methods Subjects were 12 355 pregnant women who had joined in the Anhui Birth Defects and Child Development Cohort Study and delivered between October 2008 and October 2010. The relationships between pre-pregnancy BMI and SGA,LGA,LBW and macrosomia were evaluated by Chi-square analysis and non-conditional logistic regression. Results The average pre-pregnancy BMI for the pregnant women was 20. 19(2.348 kg/m2). Based on the pre-pregnancy BMI,2 834 women were classified as underweight 22.9% ),8 745 as normal (70. 8% ), and 776 as overweight or obese (6.3% ). After adjusted for confounding factors such as age,registered residence, and pregnant times, we figured out the relationship between pre-pregnancy BMI and the gestational age group and the birth weight group. Pregnant underweight increased the risk of SGA(odds ratio[OR] =1.320,95% confidence interval[ CI: 1.068-1. 631] ,pre-pregnant overweight and obesity increased the risks of LGA(OR = 1. 758,95% CIA. 503 -2.056)and macrosomia(OR = 1. 870,95%CI:1. 540 -2.271). Conclusion High or low pre-pregnancy BMI could effect birth outcomes.%目的 探讨孕前体质指数(BMI)与4种不良妊娠结局(小于胎龄儿、大于胎龄儿、低出生体重儿、巨大儿)的关系.方法 以2008年10月-2010年10月在安徽省8个地市的妇幼保健机构孕早期建卡并随访到分娩记录的12 355名孕妇为对象,采用x2检验和非条件Logistic回归分析模型,分析孕前BMI与4种不良妊娠结局的关系.结果 孕妇孕前BMI均数为(20.19±2.348)kg/m2,过低2834人(22.9%),正常8745人(70.8%),超重及肥胖776人(6.3%);调整年龄、户籍地、孕次等混杂因素后,对孕前BMI与胎龄儿组和体重儿组分别进行关联性分析,结果显示,孕前BMI过

  13. Preterm birth and its outcome

    Directory of Open Access Journals (Sweden)

    Farhin Radhanpuri

    2014-02-01

    Conclusions: In our population preterm birth is more common in poor socio economic status, women with anaemia, malnutrition and these factors can be eliminated by proper nutrition and health education by health workers. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 153-157

  14. Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Diego F. Wyszynski

    2016-01-01

    Full Text Available Objective. To examine pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura (ITP or chronic ITP (cITP diagnosed before or during pregnancy. Methods. A linkage of mothers and babies within a large US health insurance database that combines enrollment data, pharmacy claims, and medical claims was carried out to identify pregnancies in women with ITP or cITP. Outcomes included preterm birth, elective and spontaneous loss, and major congenital anomalies. Results. Results suggest that women diagnosed with ITP or cITP prior to their estimated date of conception may be at higher risk for stillbirth, fetal loss, and premature delivery. Among 446 pregnancies in women with ITP, 346 resulted in live births. Women with cITP experienced more adverse outcomes than those with a pregnancy-related diagnosis of ITP. Although 7.8% of all live births had major congenital anomalies, the majority were isolated heart defects. Among deliveries in women with cITP, 15.2% of live births were preterm. Conclusions. The results of this study provide further evidence that cause and duration of maternal ITP are important determinants of the outcomes of pregnancy.

  15. Tobacco Control Policies, Birth Outcomes, and Maternal Human Capital

    OpenAIRE

    Sara Markowitz; Kathleen Adams, E; Dietz, Patricia M.; Viji Kannan; Tong, Van T.

    2013-01-01

    Smoking during pregnancy can have significant adverse health effects for babies, yet many women smoke during pregnancy. In this paper, we examine whether state tobacco control policies lead to improved birth outcomes and to what extent the success of these policies depends on accumulated maternal human capital. We use data from the Pregnancy Risk Assessment Monitoring System in a time period when states significantly changed their tobacco control policies. Results show that the smoking polici...

  16. Navajo birth outcomes in the Shiprock uranium mining area

    International Nuclear Information System (INIS)

    The role of environmental radiation in the etiology of birth defects, stillbirths, and other adverse outcomes of pregnancy was evaluated for 13,329 Navajos born at the Public Health Service/Indian Health Service Hospital in the Shiprock, NM, uranium mining area (1964-1981). More than 320 kinds of defective congenital conditions were abstracted from hospital records. Using a nested case-control design, families of 266 pairs of index and control births were interviewed. The only statistically significant association between uranium operations and unfavorable birth outcome was identified with the mother living near tailings or mine dumps. Among the fathers who worked in the mines, those of the index cases had histories of more years of work exposure but not necessarily greater gonadal dosage of radiation. Also, birth defects increased significantly when either parent worked in the Shiprock electronics assembly plant. Overall, the associations between adverse pregnancy outcome and exposure to radiation were weak and must be interpreted with caution with respect to implying a biogenetic basis

  17. Alcohol Taxes and Birth Outcomes

    Directory of Open Access Journals (Sweden)

    Ning Zhang

    2010-04-01

    Full Text Available This study examines the relationships between alcohol taxation, drinking during pregnancy, and infant health. Merged data from the US Natality Detailed Files, as well as the Behavioral Risk Factor Surveillance System (1985–2002, data regarding state taxes on beer, wine, and liquor, a state- and year-fixed-effect reduced-form regression were used. Results indicate that a one-cent ($0.01 increase in beer taxes decreased the incidence of low-birth-weight by about 1–2 percentage points. The binge drinking participation tax elasticity is −2.5 for beer and wine taxes and −9 for liquor taxes. These results demonstrate the potential intergenerational impact of increasing alcohol taxes.

  18. Can Higher Cigarette Taxes Improve Birth Outcomes?

    OpenAIRE

    Evans, William N.; Ringel, Jeanne S

    1997-01-01

    This study uses within-state variation in taxes over the 1989-1992 time period to test whether maternal smoking and birth outcomes are responsive to higher state cigarette taxes. Data on the outcomes of interest are taken from the Natality Detail files, generating a sample of roughly 10.5 million births. The results indicate that smoking participation declines when excise taxes are increased. The elasticity of demand for cigarettes is estimated to be appro- ximately -0.25. In addition, estima...

  19. Mechanisms underlying the associations of maternal age with adverse perinatal outcomes

    DEFF Research Database (Denmark)

    Lawlor, Debbie A; Mortensen, Laust; Andersen, Anne-Marie Nybo

    2011-01-01

    The mechanisms underlying the association between maternal age (both young and older maternal age) and adverse perinatal outcomes are unclear. Methods We examined the association of maternal age at first birth with preterm birth (..., such as childhood socio-economic characteristics—a confounder we hypothesized would exaggerate the young maternal age–adverse outcomes association but mask the older maternal age–adverse outcome association. Results There was a U-shaped association of maternal age with risk of preterm birth (lowest risk age 24......–30 years) and SGA (lowest risk age 26–30 years) in cohort analyses. In analyses with sister control, there was a J-shaped association of maternal age with preterm birth, with a monotonic increase in risk across the maternal age range from 24 years of maternal age. For SGA, risk increased across the age...

  20. Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study.

    OpenAIRE

    Padhi, Bijaya K.; Baker, Kelly K.; Ambarish Dutta; Oliver Cumming; Freeman, Matthew C.; Radhanatha Satpathy; Das, Bhabani S.; Pinaki Panigrahi

    2015-01-01

    Editors' Summary Background Pregnancy is usually a happy time for women and their families. But, for some women, pregnancy ends unhappily. Some women lose their baby during early pregnancy (spontaneous abortion or miscarriage) or during late pregnancy (stillbirth). Others have their baby earlier than expected (preterm birth) or have a baby with low birth weight, two outcomes that adversely affect the baby’s survival and long-term health. The burden of adverse pregnancy outcomes (low birth wei...

  1. RISK FACTOR PROFILES OF ADVERSE NEUROMOTOR OUTCOME IN INFANTS

    Directory of Open Access Journals (Sweden)

    Farin SOLEIMANI

    2011-02-01

    Full Text Available ObjectiveAssessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in term and near-term infants.Material & MethodsThis case-control study was a representative sample of infants from different health-care centers of north and east of Tehran. The association betweenrisk factors and delayed motor development (developmental quotient below 70 indicating a significant delay was analyzed using correlating risk factors;including the perinatal and neonatal data to the developmental status. The case group consisted of 143 infants whose DQ score was less than 70 and thecontrol group consisted of 140 infants who had a DQ score of more than 70.ResultsNeonatal seizures, Apgar score less than 3 after 5 minutes of birth (OR = 2.87 [95% CI; 1.68, 4.92], low birth weight (OR = 5.86 [95% CI; 3.07, 11.18], pretermdelivery (OR =6.17 [95% CI; 3.04, 12.52], Premature rupture of membranes (PROM>24 hours (OR = 6.18[95% CI; 2.07, 18.51] and hyperbilirubinemialeading to phototherapy or exchange transfusion (OR =3.75 [95% CI; 2.12, 6.65] were associated with an increased risk for neuromotor delay on developmentalexamination at 1 year.ConclusionThis study identified distinct risk factors for an adverse outcome in infants. In this environment, perinatal risk predictors are most important.Keywords: Neurodevelopmental outcome, perinatal period, infant, risk factor.

  2. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada.

    OpenAIRE

    Liu, Shiliang; Krewski, Daniel; Shi, Yuanli; Chen, Yue; Richard T. Burnett

    2003-01-01

    The association between ambient air pollution and adverse health effects, such as emergency room visits, hospitalizations, and mortality from respiratory and cardiovascular diseases, has been studied extensively in many countries, including Canada. Recently, studies conducted in China, the Czech Republic, and the United States have related ambient air pollution to adverse pregnancy outcomes. In this study, we examined association between preterm birth, low birth weight, and intrauterine growt...

  3. Disease activity in pregnant women with Crohn's disease and birth outcomes: a regional Danish cohort study

    DEFF Research Database (Denmark)

    Nørgård, Bente; Hundborg, Heidi H; Jacobsen, Bent Ascanius;

    2007-01-01

    OBJECTIVES: CD is associated with increased risk of adverse birth outcomes, but existing studies have not assessed the impact of disease activity during pregnancy. We examined the impact of disease activity on birth outcomes: LBW, preterm birth, LBW at term, and CAs. METHODS: All births by CD women...... of clinical details (including disease activity and drug therapy during pregnancy). The exposed cohort (N = 71) constituted pregnancies with low/moderate-high disease activity during pregnancy, and the unexposed cohort (N = 86) those with inactive disease. Logistic regression analyses were used to estimate...... the adjusted relative risks (with 95% confidence intervals) for adverse birth outcomes associated with disease activity in CD pregnancies. In subanalysis, we examined the impact of moderate-high activity. RESULTS: In women with disease activity, the adjusted risks of LBW, LBW at term, preterm birth, and CAs...

  4. Effects of maternal psychotropic drug dosage on birth outcomes

    Directory of Open Access Journals (Sweden)

    Michielsen LA

    2013-12-01

    Full Text Available Laura A Michielsen,1 Frank MMA van der Heijden,1 Paddy KC Janssen,2 Harold JH Kuijpers11Vincent van Gogh Institute for Psychiatry, Venlo, the Netherlands; 2Department of Pharmacy, VieCuri Medical Centre, Venlo, the NetherlandsBackground: The aim of this retrospective study was to explore the relationship between psychotropic medication dosage and birth outcomes.Methods: A total of 136 women were enrolled, who had an active mental disorder, were taking medication to prevent a relapse, or had a history of postpartum depression or psychosis. Medication use was evaluated for the three trimesters and during labor. Based on the defined daily dose, medication use was classified into three groups. Primary outcome variables included the infant gestational age at birth, birth weight, and Apgar scores at one and 5 minutes.Results: Our study showed a significantly higher incidence of Apgar score ≤7 at 5 minutes in women taking psychotropic drugs as compared with the group taking no medication, respectively (16.3% versus 0.0%, P=0.01. There was no significant difference between the two groups in Apgar score at one minute or in gestational age and birth weight. The results showed no significant differences in gestational age, birth weight, or Apgar scores for a low–intermediate or high dose of a selective serotonin reuptake inhibitor and for a low or intermediate dose of an antipsychotic.Conclusion: This study does not indicate a relationship between doses of selective serotonin reuptake inhibitors and antipsychotics and adverse neonatal outcomes.Keywords: pregnancy, psychotropic medication, dosage, birth outcomes

  5. RISK FACTOR PROFILES OF ADVERSE NEUROMOTOR OUTCOME IN INFANTS

    Directory of Open Access Journals (Sweden)

    Farin Soleimani MD

    2010-12-01

    Full Text Available ObjectiveAssessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in term and near-term infants.Material & MethodsThis case-control study was a representative sample of infants from different health-care centers of north and east of Tehran. The association betweenrisk factors and delayed motor development (developmental quotient below 70 indicating a significant delay was analyzed using correlating risk factors;including the perinatal and neonatal data to the developmental status. The case group consisted of 143 infants whose DQ score was less than 70 and thecontrol group consisted of 140 infants who had a DQ score of more than 70.ResultsNeonatal seizures, Apgar score less than 3 after 5 minutes of birth (OR = 2.87 [95% CI; 1.68, 4.92], low birth weight (OR = 5.86 [95% CI; 3.07, 11.18], pretermdelivery (OR =6.17 [95% CI; 3.04, 12.52], Premature rupture of membranes (PROM>24 hours (OR = 6.18[95% CI; 2.07, 18.51] and hyperbilirubinemialeading to phototherapy or exchange transfusion (OR =3.75 [95% CI; 2.12, 6.65] were associated with an increased risk for neuromotor delay on developmentalexamination at 1 year.ConclusionThis study identified distinct risk factors for an adverse outcome in infants. In this environment, perinatal risk predictors are most important.

  6. Adverse blood transfusion outcomes: establishing causation.

    Science.gov (United States)

    Isbister, James P; Shander, Aryeh; Spahn, Donat R; Erhard, Jochen; Farmer, Shannon L; Hofmann, Axel

    2011-04-01

    The transfusion of allogeneic red blood cells (RBCs) and other blood components is ingrained in modern medical practice. The rationale for administering transfusions is based on key assumptions that efficacy is established and risks are acceptable and minimized. Despite the cliché that, "the blood supply is safer than ever," data about risks and lack of efficacy of RBC transfusions in several clinical settings have steadily accumulated. Frequentist statisticians and clinicians demand evidence from randomized clinical trials (RCTs); however, causation for the recognized serious hazards of allogeneic transfusion has never been established in this manner. On the other hand, the preponderance of evidence implicating RBC transfusions in adverse clinical outcomes related to immunomodulation and the storage lesion comes from observational studies, and a broad and critical analysis to evaluate causation is overdue. It is suggested in several circumstances that this cannot wait for the design, execution, and conduct of rigorous RCTs. We begin by examining the nature and definition of causation with relevant examples from transfusion medicine. Deductive deterministic methods may be applied to most of the well-accepted and understood serious hazards of transfusion, with modified Koch's postulates being fulfilled in most circumstances. On the other hand, when several possible interacting risk factors exist and RBC transfusions are associated with adverse clinical outcomes, establishing causation requires inferential probabilistic methodology. In the latter circumstances, the case for RBC transfusions being causal for adverse clinical outcomes can be strengthened by applying modified Bradford Hill criteria to the plethora of existing observational studies. This being the case, a greater precautionary approach to RBC transfusion is necessary and equipoise that justifying RCTs may become problematic. PMID:21345639

  7. The influence of thyroid disorders on adverse pregnancy outcomes

    NARCIS (Netherlands)

    R. Vissenberg

    2016-01-01

    This thesis explores the association between thyroid disorders and adverse pregnancy outcomes, the underlying pathophysiology and treatment possibilities. The association between thyroid disorders and adverse pregnancy outcomes is investigated in a systematic review and two retrospective cohort stud

  8. Adverse Outcome Pathway (AOP) Network Development for Fatty Liver

    Science.gov (United States)

    Adverse outcome pathways (AOPs) are descriptive biological sequences that start from a molecular initiating event (MIE) and end with an adverse health outcome. AOPs provide biological context for high throughput chemical testing and further prioritize environmental health risk re...

  9. The risk of adverse pregnancy outcome after bariatric surgery

    DEFF Research Database (Denmark)

    Kjær, Mette Karie Mandrup; Lauenborg, Jeannet; Breum, Birger Michael;

    2013-01-01

    The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery.......The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery....

  10. Population-based investigations to study the association of cardiovascular polymorphisms and adverse pregnancy outcome

    DEFF Research Database (Denmark)

    Lykke, Jacob Alexander; Langhoff-Roos, Jens; Young, Bradford;

    2007-01-01

    Adverse pregnancy outcome refers to placenta-mediated complications that may share a common etiopathogenesis in some cases. Unraveling associations between prothrombotic genetic predispositions and these pregnancy disorders, namely recurrent fetal loss, stillbirth, severe preeclampsia, intrauteri...... pro-thrombotic and cardiovascular genetic polymorphisms. These studies are urgently needed to accurately assess the linkage between family history, presence of adverse pregnancy outcome, and long-term cardiovascular risk....... growth restriction, and placental abruption, requires rigorous epidemiological studies involving large cohorts of patients with sufficient numbers of the adverse pregnancy outcomes in question. Such is the case with the Denmark National Birth Cohort, which was initiated in 1996 and followed pregnant...

  11. The relationship between salivary bacterial flora and adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Sadeghi R

    2011-04-01

    Full Text Available "n 800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Background: Many studies have shown that periodontal pathogens are emerging as a risk factor for preterm delivery and low birth weight, but there are few studies about the relationship between other oral bacteria and pregnancy outcomes. The aim of the present study was to determine the relationship between salivary bacteria and pregnancy outcomes."n"nMethods: This cohort study was performed on 300 pregnant women who were recruited from the prenatal clinic of Zeynab Hospital in Tehran during 2009-2010. The patients' demographic and pregnancy data were recorded. Using samplers, saliva samples were collected about one hour after breakfast. Microbial evaluation was performed by counting the bacteria based on their shape and the Gram reaction. The studied bacteria were composed of gram-positive and negative cocci, gram-positive and negative bacilli, spirilla, spirochetes, yeasts, fusiform bacteria and actinomycetes."n"nResults: The data on the bacteriological profile and pregnancy outcome of 243 out of the 300 eligible participants of the study were completed. Five cases (2% had intra uterine fetal death (IUFD while 238 (98% delivered live infants. There was a significant statistical relationship between the mean of gram-negative cocci and IUFD (P=0.04. 10 cases (4.1% of 243, experienced adverse delivery outcomes and 233 cases (95% had normal delivery. The adverse pregnancy outcomes had a significant relationship with the presence of spirochetes in saliva (P<0.05 but this relationship was not

  12. Interpregnancy interval raise odds of adverse perinatal outcome in high fertility region Mewat, Haryana

    Directory of Open Access Journals (Sweden)

    Anam ul Haq

    2014-06-01

    Methods: Retrospective cross sectional study in which 400 meo women (para 2 to para 5 fulfilling inclusion and exclusion criteria having diverse interpregnancy intervals were selected. Statistical analysis was done using SPSS. We used multivariate logistic regression analysis to assess the risk of adverse perinatal outcome. Results: As compared with infants conceived within a time period of 16 to 48 months after a live birth, infants conceived within 16 months after a live birth had odds ratios of 2.1 (95% CI 1.3 to 3.5 for low birth weight, 2.2 (95% CI 1.3 to 3.8 for preterm birth, and 2.3 (95% CI 1.4 to 3.8 for small size for gestational age; infants conceived more than 48 months after a live birth had odds ratios of 1.88 (95% CI 1.1 to 3.1, 1.96 (95% CI 1.1 to 3.4, and 2.08 (95% CI 1.2 to 3.6 for these three adverse outcomes, respectively; P value <0.05. Conclusions: We came to conclusion that interpregnancy interval of 16 - 48 months is the optimal interval carrying least risk of adverse perinatal outcomes and both short as well as long interpregnancy intervals are significantly associated with birth of preterm, low birth weight and small for gestational age babies. Counselling regarding optimal interpregnancy interval and methods of contraception can go a long way in reducing adverse perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 598-603

  13. Spontaneous preterm birth : prevention, management and outcome

    NARCIS (Netherlands)

    Vermeulen, Gustaaf Michiel

    2001-01-01

    Preterm birth (birth before 37 completed weeks of pregnancy) is a major cause of perinatal morbidity and mortality. Strategies to prevent and adequately treat preterm labour, in order to postpone birth and to identify risk factors for neonatal damage due to preterm birth, have to be developed by obs

  14. Birth Outcomes and Prenatal Exposure to Ozone, Carbon Monoxide, and Particulate Matter: Results from the Children’s Health Study

    OpenAIRE

    Salam, Muhammad T.; Millstein, Joshua; Li, Yu-Fen; Lurmann, Frederick W.; Margolis, Helene G.; Gilliland, Frank D

    2005-01-01

    Exposures to ambient air pollutants have been associated with adverse birth outcomes. We investigated the effects of air pollutants on birth weight mediated by reduced fetal growth among term infants who were born in California during 1975–1987 and who participated in the Children’s Health Study. Birth certificates provided maternal reproductive history and residence location at birth. Sociodemographic factors and maternal smoking during pregnancy were collected by questionnaire. Monthly aver...

  15. Prenatal lignan exposures, pregnancy urine estrogen profiles and birth outcomes

    International Nuclear Information System (INIS)

    During pregnancy, human exposure to endogenous estrogens and xenoestrogens (such as lignans) may comprehensively impact the gestational maintenance and fetal growth. We measured the concentrations of 5 lignans and the profile of 13 estrogen metabolites (EMs) in the urine samples of 328 pregnant women and examined their associations with birth outcomes. We found significantly positive associations between gestational age and urinary matairesinol (MAT), enterodiol (END) and enterolactone (ENL), as well as 16-hydroxylation pathway EMs. There were consistently positive relationships between END and the 16-hydroxylation pathway EMs. The positive relationships of MAT, END and ENL exposures with the length of gestation were mainly in the low exposure strata of the levels of these EMs. This study reveals that MAT, END and ENL as well as 16-hydroxylation pathway EMs are associated with birth outcomes, and that there are interactive relationships between lignans and 16-hydroxylation pathway EMs with birth outcomes. - Highlights: • We examined relations between prenatal lignan exposures and birth outcomes. • We examined relations between pregnancy urine estrogen profiles and birth outcomes. • MAT, END and ENL are associated with birth outcomes. • 16-hydroxylation pathway EMs are associated with birth outcomes. • There are interactive relationships between ligans and EMs with birth outcomes. - Prenatal lignan exposures and EM levels were interactively related to birth outcomes

  16. Adverse pregnancy outcomes in rural Maharashtra, India (2008–09: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Doke Prakash

    2012-07-01

    Full Text Available Abstract Background The study was carried out to record adverse pregnancy outcomes and to obtain information about sex ratio at birth in rural especially tribal areas in the State of Maharashtra, India. Although the tribal population is considered vulnerable to innumerable adversities, regretfully information about pregnancy wastage among them is not available. About 10% population of the state is tribal. The study of sex ratio at birth was planned as the overall sex ratio and child sex ratio had declined in the state. Methods The cohort of antenatal cases registered in rural areas of Maharashtra in the calendar year 2008 was followed up to study the pregnancy outcomes. A retrospective study was carried out from October 2009 to August 2010. The outcomes of all the registered antenatal cases were recorded by the Auxiliary Nurse Midwives. The summary sheets were obtained by Block Medical Officers. The data was entered at the block level by trained data entry operators in specially designed web-based software. Adverse pregnancy outcome was categorized in two groups abortions and stillbirths. Results About 1.1 million registered pregnancies were followed up. In the state 5.34% registered pregnancies ended in abortions. In tribal PHCs the relative risk of spontaneous abortion and induced abortion was 0.91and 0.38 respectively. It was also revealed that about 1.55% pregnancies culminated in stillbirth. The relative risk of stillbirths in tribal PHCs was 1.33. The sex ratio at birth in the state was 850. The ratio was 883 in the tribal PHCs. Correlation was observed between sex ratio at birth and induced abortion rate. Conclusions The study indicates that women from tribal PHCs are exposed to higher risk of adverse pregnancy outcome in the form of stillbirths. In non-tribal areas high induced abortion rate and poor sex ratio at birth is observed. These two indicators are correlated. The correlation may be explained by the unscrupulous practice of sex

  17. Periodontal Treatment for Preventing Adverse Pregnancy Outcomes: A Meta- and Trial Sequential Analysis

    Science.gov (United States)

    Schwendicke, Falk; Karimbux, Nadeem; Allareddy, Veerasathpurush; Gluud, Christian

    2015-01-01

    Objectives Periodontal treatment might reduce adverse pregnancy outcomes. The efficacy of periodontal treatment to prevent preterm birth, low birth weight, and perinatal mortality was evaluated using meta-analysis and trial sequential analysis. Methods An existing systematic review was updated and meta-analyses performed. Risk of bias, heterogeneity, and publication bias were evaluated, and meta-regression performed. Subgroup analysis was used to compare different studies with low and high risk of bias and different populations, i.e., risk groups. Trial sequential analysis was used to assess risk of random errors. Results Thirteen randomized clinical trials evaluating 6283 pregnant women were meta-analyzed. Four and nine trials had low and high risk of bias, respectively. Overall, periodontal treatment had no significant effect on preterm birth (odds ratio [95% confidence interval] 0.79 [0.57-1.10]) or low birth weight (0.69 [0.43-1.13]). Trial sequential analysis demonstrated that futility was not reached for any of the outcomes. For populations with moderate occurrence (<20%) of preterm birth or low birth weight, periodontal treatment was not efficacious for any of the outcomes, and trial sequential analyses indicated that further trials might be futile. For populations with high occurrence (≥20%) of preterm birth and low birth weight, periodontal treatment seemed to reduce the risk of preterm birth (0.42 [0.24-0.73]) and low birth weight (0.32 [0.15-0.67]), but trial sequential analyses showed that firm evidence was not reached. Periodontal treatment did not significantly affect perinatal mortality, and firm evidence was not reached. Risk of bias, but not publication bias or patients’ age modified the effect estimates. Conclusions Providing periodontal treatment to pregnant women could potentially reduce the risks of perinatal outcomes, especially in mothers with high risks. Conclusive evidence could not be reached due to risks of bias, risks of random

  18. Birth order and child outcomes: does maternal quality time matter?

    OpenAIRE

    Monfardini, Chiara; See, Sarah Grace

    2012-01-01

    Higher birth order positions are often associated with poorer outcomes, possibly due to fewer resources received within the household. Using a sample of PSID-CDS children, we investigate whether the birth order effects in their outcomes are due to unequal allocation of the particular resource represented by maternal quality time. OLS regressions show that the negative birth order effects on various test scores are only slightly diminished when maternal time is included among the regressors. T...

  19. Adverse reproductive outcomes among female veterinarians

    International Nuclear Information System (INIS)

    Because female veterinarians are exposed to several known reproductive hazards, the authors conducted a reproductive survey of all female graduates of a US veterinary school (n = 537) and law school (comparison group, n = 794). Analysis was confined to pregnancies completed after the second year of professional school and from 1966 to 1986. Based on one randomly chosen eligible pregnancy per woman (veterinarians, n = 176; lawyers, n = 229), spontaneous abortion rates, adjusted for elective abortions, were 13.3% for the veterinarians and 15.1% for the lawyers; these did not differ significantly. A Cox life table regression model controlling for age, smoking, alcohol use, and prior spontaneous abortion also showed no significant difference in spontaneous abortion rates between the two populations. Using all pregnancies, veterinarians who reported performing five or more radiographic examinations per week had a marginally elevated risk of spontaneous abortion, but the statistical significance disappeared when analysis was limited to one random pregnancy per woman. For one random eligible birth per woman, the mean birth weight did not differ significantly between the veterinarians and lawyers, even after controlling for possible confounders in regression analyses. A higher rate of reportable birth defects was observed among the veterinarians than among the lawyers (relative risk = 4.2, 95% confidence interval 1.2-15.1), but this unexpected result must be considered hypothesis-generating. The authors did not find an overall increased risk for spontaneous abortion or low birth weight infants among veterinarians compared with lawyers, but veterinarians who reported performing five or more radiographic examinations per week may have been at increased risk for spontaneous abortion

  20. Neonatal outcomes after preterm birth by mothers’ health insurance status at birth: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Einarsdóttir Kristjana

    2013-02-01

    Full Text Available Abstract Background Publicly insured women usually have a different demographic background to privately insured women, which is related to poor neonatal outcomes after birth. Given the difference in nature and risk of preterm versus term births, it would be important to compare adverse neonatal outcomes after preterm birth between these groups of women after eliminating the demographic differences between the groups. Methods The study population included 3085 publicly insured and 3380 privately insured, singleton, preterm deliveries (32–36 weeks gestation from Western Australia during 1998–2008. From the study population, 1016 publicly insured women were matched with 1016 privately insured women according to the propensity score of maternal demographic characteristics and pre-existing medical conditions. Neonatal outcomes were compared in the propensity score matched cohorts using conditional log-binomial regression, adjusted for antenatal risk factors. Outcomes included Apgar scores less than 7 at five minutes after birth, time until establishment of unassisted breathing (>1 minute, neonatal resuscitation (endotracheal intubation or external cardiac massage and admission to a neonatal special care unit. Results Compared with infants of privately insured women, infants of publicly insured women were more likely to receive a low Apgar score (ARR = 2.63, 95% CI = 1.06-6.52 and take longer to establish unassisted breathing (ARR = 1.61, 95% CI = 1.25-2.07, yet, they were less likely to be admitted to a special care unit (ARR = 0.84, 95% CI = 0.80-0.87. No significant differences were evident in neonatal resuscitation between the groups (ARR = 1.20, 95% CI = 0.54-2.67. Conclusions The underlying reasons for the lower rate of special care admissions in infants of publicly insured women compared with privately insured women despite the higher rate of low Apgar scores is yet to be determined. Future research is

  1. EXPOSURE TO AREA-LEVEL PRETERM BIRTH DISPARITY AND EFFECTS ON BIRTH OUTCOMES

    Science.gov (United States)

    Black–white disparity in preterm birth (PTB) is persistent and not explained by individual factors. Given that exposure to inequality is associated with increased risk of adverse health, we examined PTB risk (birth <37 weeks gestational age) explained by living in U.S. census tra...

  2. Birth and perinatal outcomes and complications for babies conceived following ART

    DEFF Research Database (Denmark)

    Henningsen, Anna-Karina Aaris; Pinborg, Anja

    2014-01-01

    Children born after assisted reproductive techniques (ART) have an increased risk of several adverse perinatal outcomes compared with their naturally conceived peers. This has various causes such as higher multiple birth rates, parental characteristics and higher maternal age, with more being...

  3. The potential contribution of marital-cohabitation status to racial, ethnic, and nativity differentials in birth outcomes in Texas.

    Science.gov (United States)

    Sullivan, Kate; Raley, R Kelly; Hummer, Robert A; Schiefelbein, Emily

    2012-05-01

    Disparities in infant mortality by race/ethnicity and nativity are widely known. Patterns of marriage and union formation also vary by race, ethnicity and nativity and may contribute to disparities in birth outcomes. Using population level data, we build on previous research of race/ethnic disparities in birth outcomes by investigating the role of union status. Data come from the 2006 Birth Record from Texas Vital Statistics. The final sample size included 369,839 births to Texas women aged 18 and older. Birth outcomes were constructed from indicators of low birth weight and preterm birth. Logistic regression estimates odds of low birth weight and preterm birth by race/ethnicity and nativity and union status. Race/ethnicity/nativity and union status are significant and independent predictors of birth outcomes. US born Black and Mexican Origin mothers had higher odds of preterm birth and low birth weight babies compared to US born White mothers. Unmarried mothers had higher odds of adverse birth outcomes compared to married women. There was only modest support that the association between race/ethnicity/nativity status and birth outcomes could be explained by divergent patterns in union status. Though disparities in birth outcomes are persistent across race, ethnicity and nativity, the results suggest that union status at birth is a very weak factor in accounting for these disparities. Differing patterns in union status did not account for the Black-White and Mexican Origin-White gaps in infant health outcomes. Additional research aimed at uncovering the processes that put these mothers and infants at higher risk is needed.

  4. Adverse Perinatal Outcome in Subsequent Pregnancy after Stillbirth by Placental Vascular Disorders.

    Directory of Open Access Journals (Sweden)

    Francesca Monari

    Full Text Available To evaluate outcome in the pregnancy following a stillbirth (SB by a placental vascular disorders.A prospective, observational, multicenter study was conducted in woman with a history of stillbirth (> 22 weeks between 2005 and June 2013, in 3 Italian University Hospitals. Causes of SB were previously identified after extensive investigations. Pregnant women were enrolled within the first trimester. The main outcome was "adverse neonatal outcome", including perinatal death, fetal growth restriction, early preterm birth <33+6 weeks, hypoxic-ischemic encephalopathy, intracranial hemorrhage or respiratory distress.Out of 364 index pregnancies, 320 women (87.9% had a subsequent pregnancy during the study period. Forty-seven had an early pregnancy loss. Out of 273 babies, 67 (24.5% had an adverse perinatal outcome, including 1 SB and 1 early neonatal death (3.7/1000. Women who had a SB related to placental vascular disorders (39.6%, were at higher risk of an adverse neonatal outcome compared with women whose SB was unexplained or resulted from other causes (Adj. OR = 2.1, 95%CI: 1.2-3.8. Moreover, also obesity independently predicts an adverse perinatal outcome (Adj OR = 2.1, 95%CI: 1.1-4.3.When previous SB is related to placental vascular disorders there is a high risk for adverse neonatal outcomes in the subsequent pregnancy. Maternal obesity is an additional risk factor.

  5. Early spontaneous multiple fetal pregnancy reduction is associated with adverse perinatal outcomes in in vitro fertilization cycles.

    Science.gov (United States)

    Petrini, Allison C; Pereira, Nigel; Lekovich, Jovana P; Elias, Rony T; Spandorfer, Steven D

    2016-07-01

    The primary objective of this study is to investigate whether early spontaneous multiple fetal pregnancy reduction, also known as vanishing twin syndrome, is associated with adverse perinatal outcomes in fresh in vitro fertilization cycles. This is a retrospective cohort study of women with live singleton births with and without an early vanishing twin after fresh in vitro fertilization. Characteristics compared included incidence of preterm birth, overall birth weight, overall low birth weight, overall very low birth weight, and term low birth weight. In all, 4049 patients with live singleton births were included-853 and 3196 with and without a vanishing twin, respectively. The vanishing twin group had a lower overall birth weight compared to those without (3279.5 ± 369.9 vs 3368.6 ± 567.5 g; p vitro fertilization. PMID:27638897

  6. Missing paternal demographics: A novel indicator for identifying high risk population of adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Wen Shi

    2004-11-01

    Full Text Available Abstract Background One of every 6 United Status birth certificates contains no information on fathers. There might be important differences in the pregnancy outcomes between mothers with versus those without partner information. The object of this study was to assess whether and to what extent outcomes in pregnant women who did not have partner information differ from those who had. Methods We carried out a population-based retrospective cohort study based on the registry data in the United States for the period of 1995–1997, which was a matched multiple birth file (only twins were included in the current analysis. We divided the study subjects into three groups according to the availability of partner information: available, partly missing, and totally missing. We compared the distribution of maternal characteristics, maternal morbidity, labor and delivery complications, obstetric interventions, preterm birth, fetal growth restriction, low birth weight, congenital anomalies, fetal death, neonatal death, post-neonatal death, and neonatal morbidity among three study groups. Results There were 304466 twins included in our study. Mothers whose partner's information was partly missing and (especially totally missing tended to be younger, of black race, unmarried, with less education, smoking cigarette during pregnancy, and with inadequate prenatal care. The rates of preterm birth, fetal growth restriction, low birth weight, Apgar score Conclusions Mothers whose partner's information was partly and (especially totally missing are at higher risk of adverse pregnant outcomes, and clinicians and public health workers should be alerted to this important social factor.

  7. Asthma during pregnancy in a population-based study--pregnancy complications and adverse perinatal outcomes.

    Directory of Open Access Journals (Sweden)

    Gustaf Rejnö

    Full Text Available BACKGROUND: Asthma is one of the most common chronic diseases, and prevalence, severity and medication may have an effect on pregnancy. We examined maternal asthma, asthma severity and control in relation to pregnancy complications, labour characteristics and perinatal outcomes. METHODS: We retrieved data on all singleton births from July 1, 2006 to December 31, 2009, and prescribed drugs and physician-diagnosed asthma on the same women from multiple Swedish registers. The associations were estimated with logistic regression. RESULTS: In total, 266 045 women gave birth to 284 214 singletons during the study period. Maternal asthma was noted in 26 586 (9.4% pregnancies. There was an association between maternal asthma and increased risks of pregnancy complications including preeclampsia or eclampsia (adjusted OR 1.15; 95% CI 1.06-1.24 and premature contractions (adj OR 1.52; 95% CI 1.29-1.80. There was also a significant association between maternal asthma and emergency caesarean section (adj OR 1.29; 95% CI 1.23-1.34, low birth weight, and small for gestational age (adj OR 1.23; 95% CI 1.13-1.33. The risk of adverse outcomes such as low birth weight increased with increasing asthma severity. For women with uncontrolled compared to those with controlled asthma the results for adverse outcomes were inconsistent displaying both increased and decreased OR for some outcomes. CONCLUSION: Maternal asthma is associated with a number of serious pregnancy complications and adverse perinatal outcomes. Some complications are even more likely with increased asthma severity. With greater awareness and proper management, outcomes would most likely improve.

  8. MORTALITY AS AN ADVERSE OUTCOME OF SARCOPENIA

    OpenAIRE

    ARANGO-LOPERA, V.E.; Arroyo, P.; GUTIERREZ-ROBLEDO, L.M.; PEREZ-ZEPEDA, M.U.; Cesari, M.

    2013-01-01

    Sarcopenia has an important impact in elderly. Recently the European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as the loss of muscle mass plus low muscle strength or low physical performance. Lack of clinical sounding outcomes (ie external validity), is one of the flaws of this algorithm. The aim of our study was to determine the association of sarcopenia and mortality in a group of Mexican elderly. A total of 345 elderly were recruited in Mexico City, and follow...

  9. Women referred for occupational risk assessment in pregnancy have no increased risk of adverse obstetric outcomes

    DEFF Research Database (Denmark)

    Bidstrup, Signe Brøker; Kaerlev, Linda; Thulstrup, Ane Marie;

    2015-01-01

    INTRODUCTION: Our aim was to study the association between pregnant women's referral status for occupational risk assessment, and their risk of preterm delivery (.... Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Calculations were adjusted for the mother's age at delivery, parity, ethnicity, socioeconomic status, smoking, and in supplementary analyses for year of birth. RESULTS: Referred women gave birth to children....../or that the occupational risk assessment and counselling of pregnant women are preventing these selected adverse pregnancy outcomes. FUNDING: The Research Unit at Department of Occupational and Environmental Medicine at Bispebjerg Hospital supported the study financially. TRIAL REGISTRATION: not relevant. The study...

  10. Women referred for occupational risk assessment in pregnancy have no increased risk of adverse obstetric outcomes

    DEFF Research Database (Denmark)

    Bidstrup, Signe Brøker; Kaerlev, Linda; Thulstrup, Ane Marie;

    2015-01-01

    INTRODUCTION: Our aim was to study the association between pregnant women's referral status for occupational risk assessment, and their risk of preterm delivery (.../or that the occupational risk assessment and counselling of pregnant women are preventing these selected adverse pregnancy outcomes. FUNDING: The Research Unit at Department of Occupational and Environmental Medicine at Bispebjerg Hospital supported the study financially. TRIAL REGISTRATION: not relevant. The study....... Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Calculations were adjusted for the mother's age at delivery, parity, ethnicity, socioeconomic status, smoking, and in supplementary analyses for year of birth. RESULTS: Referred women gave birth to children...

  11. "PREVALENCE, MATERNAL COMPLICATIONS AND BIRTH OUTCOME OF PHYSICAL, SEXUAL AND EMOTIONAL DOMESTIC VIOLENCE DURING PREGNANCY"

    Directory of Open Access Journals (Sweden)

    M. Faramarzi

    2005-05-01

    Full Text Available The prevalence of physical violence during pregnancy varies widely in different societies. To assess the incidence of self-reported physical, emotional and sexual violence in pregnancy and describe the association with maternal complication and birth outcomes, 3275 women who gave birth to live-born infants from October 2002 to November 2003 were assessed for self-reported violence in postpartum units of Obstetrics Department of Babol university of Medical Sciences. Outcome data included maternal antenatal hospitalizations, labor and delivery complications and low birth weights and preterm births. Odds ratios and 95% confidence intervals were calculated to measure the association between violence, maternal morbidity and birth outcomes. The prevalence of physical, sexual and emotional domestic violence was respectively 9.1%, 30.8% and 19.2%. Compared with those not reporting physical, sexual and emotional violence, women who did were more likely to deliver by cesarean and to have abnormal progress of labor, premature rupture of membranes, low birth weight, preterm birth and any hospitalization before delivery. Prevalence of physical, emotional or sexual violence during pregnancy was high and was associated with adverse fetal and maternal conditions. These findings support routine screening for physical, emotional and sexual violence in pregnancy and postpartum period to prevent consequences of domestic violence.

  12. 孕前保健对某地区出生缺陷及其他不良妊娠结局影响的观察%Effect of preconception care on birth defect and other adverse pregnancy outcomes in A certain area

    Institute of Scientific and Technical Information of China (English)

    温小鲜; 陈桂玲; 梁建文; 陈凤仪; 陶小君; 陈莲芬; 李建萍; 王耀强; 张伟强; 赖剑锋

    2014-01-01

    Objective To explore the effect of preconception care on birth defect and other adverse pregnancy outcomes in Fanyu District. Methods Select 1000 sample size for research, 500 people who used of preconception care as the observation group, and 500 people without preconception care as the control group. Eugenic knowledge and awareness, taking the case of folic acid, prenatal care and treatment, adverse pregnancy outcomes of two groups were compared. Results Aware of knowledge about eugenics, the rate of taking folic acid and the treatment of chronic diseases coverage of observation group were significantly higher than the control group(P < 0.05); At 4 weeks pregnancy diagnosis rate and birth defects in prenatal screening coverage were significantly higher than the control group(P < 0.05), and the main risk factor for early pregnancy exposure levels was significantly lower than the observation group(P < 0.05); Preterm birth and Expired pregnancy rates, the incidence of neonatal asphyxia, and the incidence of birth defects were significantly lower than the control group(P < 0.05), and the amount of postpartum bleeding was significantly lower than the control group(P<0.05), the difference is statistically significant. Conclusion Preconception care can reduce birth defects, and improve the pregnancy outcome, we should further promote the smooth development of preconception care work.%目的:探讨孕前保健对广州市番禺区出生缺陷及其他不良妊娠结局的影响。方法选择1000个样本量进行研究,将进行孕前保健的500例设为观察组,未进行孕前保健的500例设为对照组,比较两组观察对象优生知识知晓率、叶酸服用情况、产前检查与治疗及不良妊娠结局等指标。结果观察组优生知识知晓率、叶酸服用率、慢性病的治疗覆盖率均明显优于对照组(P<0.05);观察组孕4周内妊娠确诊率、出生缺陷产前筛查覆盖率明显高于对照组,妊娠早期主

  13. Adverse reproduction outcomes among employees working in biomedical research laboratories

    DEFF Research Database (Denmark)

    Wennborg, H.; Bonde, Jens Peter; Stenbeck, M.;

    2002-01-01

    a previous questionnaire investigation at the research group level according to a specific definition. The ponderal index and ratio between observed and expected birthweights were calculated. Logistic regression models were used for the analyses of dichotomous outcomes (preterm, postterm and birthweight.......4). Conclusions There was a slightly elevated risk for some reproductive outcomes among the women working with certain laboratory tasks, specifically for preterm and postterm births in relation to work with solvents and bacteria....

  14. Doppler prediction of adverse perinatal outcome in intrauterine growth restriction

    Directory of Open Access Journals (Sweden)

    Nina Mahale

    2015-02-01

    Full Text Available Background: Objective of current study was to determine and compare the diagnostic performance of Doppler ultrasonography of the fetal Middle Cerebral Artery (MCA and Umbilical Artery (UA for prediction of adverse perinatal outcome in suspected intrauterine growth restriction (IUGR. Methods: Fifty singleton pregnancies in third trimester of pregnancy with suspected intrauterine growth restriction were examined with Doppler ultrasonography of fetal MCA and UA. Results: Twenty patients of the fifty included patients had at least one major or minor adverse outcome. Major adverse outcome included perinatal deaths which included both intrauterine deaths and early neonatal deaths, hypoxic ischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage, necrotizing enterocolitis and septicemia. Minor outcomes included cesarean section for fetal distress, Apgar score below 7 at 5 minutes and admission to Neonatal Intensive Care Unit (NICU for treatment. MCA PI is the most sensitive(90% index in predicting any adverse perinatal outcome i.e. including both major and minor outcomes, Positive Predictive Value (PPV and specificity being greatest for MCA/UA PI (96.6%, 93.7%. For the major adverse outcome most sensitive (86.6% most specific (91.4% and with highest PPV (81.2% and NPV (94.1%, is MCA/UA PI. Ratio of MCA/UAPI is more sensitive (90% than PI of both the arteries alone for overall prediction of adverse perinatal outcome. Conclusions: Thus we conclude that the Doppler studies of the multiple vessels in the fetoplacental unit can help in the monitoring of the compromised fetus and can help us predicting neonatal morbidity. This may be helpful in determining the optimal time of deliveries in pregnancies complicated by IUGR. [Int J Reprod Contracept Obstet Gynecol 2015; 4(1.000: 119-130

  15. Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study

    OpenAIRE

    Koen, Nastassja; Brittain, Kirsty; Donald, Kirsten A; Barnett, Whitney; Koopowitz, Sheri; Maré, Karen; Zar, Heather J; Stein,Dan

    2016-01-01

    Background: Prenatal and peripartum trauma may be associated with poor maternal–fetal outcomes. However, relatively few data on these associations exist from low-middle income countries, and populations in transition.Objective: We investigated the prevalence and risk factors for maternal trauma and posttraumatic stress disorder (PTSD), and their association with adverse birth outcomes in the Drakenstein Child Health Study, a South African birth cohort study.Methods: Pregnant women were recrui...

  16. Association of Higher Maternal Serum Fluoride with Adverse Fetal Outcomes

    Directory of Open Access Journals (Sweden)

    Gurumurthy M Sastry

    2011-04-01

    Full Text Available Background: Despite prevalence of fluorosis in India, previous studies did not emphasize on the effect of maternal fluorosis on fetal outcomes. Objectives: To study the associations of higher maternal serum Fluoride (F with low birth weight and poor APGAR count. Methods: One hundred and eight apparently healthy pregnant women aged 17-36 years were included in the study. Samples collected were maternal and cord blood, placenta and drinking and ground water. The samples were processed and analyzed for Fluoride. Fetal gestational age was measured on ultrasound scan and the birth weight of the baby on a digital scale. Fifth minute APGAR score was measured. Results: A significant negative correlation was found for maternal serum F vs Birth weight, Gestational Age and APGAR score. Significant negative correlations were also found for cord serum F vs Birth Weight, Gestational Age and APGAR score. Fairly negative correlations were also found for birth weight, APGAR score and Gestational age compared to Fluoride concentrations in maternal surface of placenta, fetal surface of placenta and marginal side of the placenta. However, significant positive correlations were observed when Gestational age was compared with Birth weight and APGAR score. When the maternal serum F was greater than 1 ppm, there was 10.58 times higher risk for low birth weight, 8.65 times higher risk for preterm delivery and 3.8 times higher risk for low APGAR score. When the cord serum F was greater than 0.22ppm, there was 2.76 times higher risk for low birth weight, 4.6 times higher risk for preterm delivery and 2.5 times higher risk for low APGAR score. Conclusion: With increased serum F in the mother, there is an inclination towards pre term delivery, low birth weight and poor APGAR count.

  17. Maternal serum hormone concentrations for prediction of adverse outcome in threatened miscarriage.

    Science.gov (United States)

    Johns, J; Muttukrishna, S; Lygnos, M; Groome, N; Jauniaux, E

    2007-10-01

    Many serum markers have been investigated in attempts to predict the outcome of pregnancy in the first trimester, with varying degrees of success. The objective of this study was to investigate whether they can be related to pregnancy outcome in women presenting with first trimester threatened miscarriage. A cohort study of women attending the Early Pregnancy Unit of a London teaching hospital was studied. A total of 122 women presenting with bleeding in the first trimester and an ongoing pregnancy, and 33 women undergoing termination of pregnancy, were recruited. The main outcome measures were gestation at delivery, birth weight and the incidence of adverse pregnancy outcome. Inhibin A, activin A, human chorionic gonadotrophin (HCG), pregnancy-associated plasma protein-A and follistatin concentrations were all significantly lower in women who subsequently miscarried when compared with live births. Serum HCG concentrations were significantly higher in cases of threatened miscarriage compared with controls (P = 0.0009). Logistic regression analysis indicated that inhibin A alone provided the best predictor for first trimester miscarriage. This pilot study suggests that placental hormone concentrations could be useful in predicting adverse pregnancy outcome in women presenting with threatened miscarriage. Inhibin A was best at predicting the likelihood of subsequent miscarriage in this group. PMID:17908404

  18. Lead, mercury, and cadmium in umbilical cord serum and birth outcomes in Chinese fish consumers.

    Science.gov (United States)

    Tang, Mengling; Xu, Chenye; Lin, Nan; Liu, Kai; Zhang, Yongli; Yu, Xinwei; Liu, Weiping

    2016-04-01

    Heavy metals such as lead (Pb), mercury (Hg), and cadmium (Cd) were detected in the islands of Yangtze River estuary and Hangzhou bay and their exposure caused potential health risk for the residents. To assess the exposure levels of Pb, Hg, and Cd, the umbilical cord serum samples were collected from 103 mother-newborn pairs as the noninvasive specimens. The association of the concentration of Pb, Hg, and Cd with the birth outcomes was evaluated. Pb, Hg, and Cd had high exposure levels with the median concentrations at 76.20 μg L(-1) [interquartile range (IQR): 44.71, 115.80], 21.94 μg L(-1) (IQR: 15.10, 27.64), and 6.36 μg L(-1) (IQR: 3.63, 13.34), respectively. A unit increase in the Pb umbilical cord serum concentration (μg L(-1)) was significantly associated with a 0.29 cm (95% CI: -0.50, -0.09) decrease in birth height and a 0.22 cm (95%CI: -0.44, 0.00) decrease in head circumference. The middle tertile Pb and Hg exposure levels were found significantly negative effects on birth outcomes compared with low tertile exposure levels. Exposure to Cd showed no apparent effect on birth outcomes. Our results suggested that Pb and Hg exposure has potential adverse effects on birth outcomes in Chinese fish consumers from Yangtze River outlet and Hangzhou bay estuary regions.

  19. The Impact of Parental Personality on Birth Outcomes: A Prospective Cohort Study

    Science.gov (United States)

    Morisaki, Naho; Fujiwara, Takeo; Horikawa, Reiko

    2016-01-01

    Objective To investigate the effect of parental personality on birth outcomes. Design Prospective cohort study. Setting 727 pregnant women and 579 spouses receiving antenatal care at a single-center in rural Tokyo, Japan during 2010–2013. Methods We measured the association between maternal effect of parental personality traits assessed by the Cloninger’s Temperament and Character Inventory on birth outcomes, using multiple regression and adjusting for demographics. Results Maternal self-transcendence personality was inversely associated with gestational age [-0.26 (95% confidence interval (CI): -0.51 to -0.01) weeks per unit] and positively associated with preterm birth [odds ratio (OR) 2.60 (95% CI: 1.00 to 6.75) per unit], while paternal self-transcendence personality was positively associated with gestational age [0.31 (95% CI: 0.07 to 0.55) weeks per unit]. Maternal reward dependence was positively associated with fetal growth [0.30 (95% CI: 0.02 to 0.59) per unit]. Other maternal and paternal personality traits associated with adverse maternal behavior, such as novelty seeking, harm avoidance and self-directedness, were not associated with birth outcomes. Conclusion We found that specific parental personality traits can be associated with birth outcomes. PMID:27331908

  20. Proteomics for Adverse Outcome Pathway Discovery using Human Kidney Cells?

    Science.gov (United States)

    An Adverse Outcome Pathway (AOP) is a conceptual framework that applies molecular-based data for use in risk assessment and regulatory decision support. AOP development is based on effects data of chemicals on biological processes (i.e., molecular initiating events, key intermedi...

  1. Association between Intimate Partner Violence during Pregnancy and Adverse Pregnancy Outcomes in Vietnam: A Prospective Cohort Study

    Science.gov (United States)

    Van, Toan Ngo; Gammeltoft, Tine; W. Meyrowitsch, Dan; Nguyen Thi Thuy, Hanh; Rasch, Vibeke

    2016-01-01

    Background Violence against pregnant women is an increasing public health concern particularly in low- and middle-income countries. The purpose of this study was to measure the association between intimate partner violence (IPV) during pregnancy and the risk of adverse birth outcomes. Methods Prospective cohort study of 1276 pregnant women in Dong Anh district, Vietnam. Women with gestational age less than 24 weeks were enrolled and interviewed. Repeated interviews were performed at 30–34 weeks gestation to assess experience of IPV during pregnancy and again 48 hours post-delivery to assess the birth outcome including birth weight and gestational age at delivery. Results There was a statistically significant association between exposure to physical violence during pregnancy and preterm birth (PTB) or low birth weight (LBW). After adjustment for age, education, occupation, body mass index (BMI), haemoglobin level, previous adverse pregnancy outcomes, the pregnant women who were exposed to physical violence during pregnancy were five times more likely to have PTB (AOR = 5.5; 95%CI: 2.1–14.1) and were nearly six times more likely to give birth to a child of LBW (AOR = 5.7; 95%CI: 2.2–14.9) as compared to those who were not exposed to physical violence. Conclusion Exposure to IPV during pregnancy increases the risk of PTB and LBW. Case-finding for violence in relation to antenatal care may help protect pregnant women and improve pregnancy outcomes. PMID:27631968

  2. Increasing Number and Proportion of Adverse Obstetrical Outcomes among Women Living with HIV in the Ottawa Area: A 20-Year Clinical Case Series

    Science.gov (United States)

    Buchan, Sarah; Spaans, Johanna N.; Balfour, Louise

    2016-01-01

    Background. The prevalence and associated risks with adverse obstetrical outcomes among women living with HIV are not well measured. The objective of this study was to longitudinally investigate the prevalence and correlates of adverse obstetrical outcomes among women with HIV. Methods. This 20-year (1990–2010) clinical case series assessed the prevalence of adverse obstetrical outcomes among pregnant women with HIV receiving care at The Ottawa Hospital (TOH). General estimating equation modeling was used to identify factors independently associated with adverse obstetrical outcomes, while controlling for year of childbirth clustering. Results. At TOH, there were 127 deliveries among 94 women (1990–2010): 22 preterm births, 9 births with low birth weight, 12 births small for gestational age, and 4 stillbirths. Per year, the odds of adverse obstetrical outcomes increased by 15% (OR: 1.15, 95% CI: 1.03–1.30). Psychiatric illness (AOR: 2.64, 95% CI: 1.12–6.24), teen pregnancy (AOR: 3.35, 95% CI: 1.04–1.46), and recent immigrant status (AOR: 7.24, 95% CI: 1.30–40.28) were the strongest correlates of adverse obstetrical outcomes. Conclusions. The increasing number and proportion of adverse obstetrical outcomes among pregnant women with HIV over the past 20 years highlight the need for social supports and maternal and child health interventions, especially among adolescents, new immigrants, and those with a history of mental illness. PMID:27528877

  3. Increasing Number and Proportion of Adverse Obstetrical Outcomes among Women Living with HIV in the Ottawa Area: A 20-Year Clinical Case Series

    Directory of Open Access Journals (Sweden)

    Sarah Buchan

    2016-01-01

    Full Text Available Background. The prevalence and associated risks with adverse obstetrical outcomes among women living with HIV are not well measured. The objective of this study was to longitudinally investigate the prevalence and correlates of adverse obstetrical outcomes among women with HIV. Methods. This 20-year (1990–2010 clinical case series assessed the prevalence of adverse obstetrical outcomes among pregnant women with HIV receiving care at The Ottawa Hospital (TOH. General estimating equation modeling was used to identify factors independently associated with adverse obstetrical outcomes, while controlling for year of childbirth clustering. Results. At TOH, there were 127 deliveries among 94 women (1990–2010: 22 preterm births, 9 births with low birth weight, 12 births small for gestational age, and 4 stillbirths. Per year, the odds of adverse obstetrical outcomes increased by 15% (OR: 1.15, 95% CI: 1.03–1.30. Psychiatric illness (AOR: 2.64, 95% CI: 1.12–6.24, teen pregnancy (AOR: 3.35, 95% CI: 1.04–1.46, and recent immigrant status (AOR: 7.24, 95% CI: 1.30–40.28 were the strongest correlates of adverse obstetrical outcomes. Conclusions. The increasing number and proportion of adverse obstetrical outcomes among pregnant women with HIV over the past 20 years highlight the need for social supports and maternal and child health interventions, especially among adolescents, new immigrants, and those with a history of mental illness.

  4. Birth outcomes of women with celiac disease

    DEFF Research Database (Denmark)

    Nørgård, Bente; Fonager, Kirsten; Sørensen, Henrik Toft;

    1999-01-01

    OBJECTIVE: We aimed to examine birthweight, low birthweight (celiac disease in relation to their first hospitalization for the disease. METHODS: This was a historical cohort study based on The Danish Medical Birth Registry...... data of celiac women discharged from Danish hospitals from 1977-1992. The study included 211 newborns to 127 mothers with celiac disease, and 1260 control deliveries. RESULTS: Before celiac women were first hospitalized the mean birthweight of their newborns was 238 g (95% confidence interval [95% CI......] = 150, 325 g) lower than that of the control women, after adjustment for potential confounders. After the first hospitalization the mean birthweight for newborns of diseased women was higher than that of controls, by 67 g (95% CI = -88, 223 g) after adjustment for potential confounders. Before celiac...

  5. The effect of cigarette and alcohol consumption on birth outcomes

    DEFF Research Database (Denmark)

    Wüst, Miriam

    behaviors, most importantly prenatal alcohol consumption. Second, it uses prenatal maternal reports on inputs and objective administrative data on child outcomes. Both features of the data reduce the threat of recall bias and measurement error. Third, the paper identifies the effect of health behaviors...... by exploiting variation between siblings. The results of the paper confirm and extend earlier findings. Maternal smoking decreases birth weight and fetal growth, with smaller effects in sibling models. The negative alcohol effect on birth outcomes is pronounced and remains intact in sibling models. Both effects......This paper uses Danish survey and register data to examine the effect of maternal inputs on child health at birth. The paper adds to the literature in several ways: First, while previous studies mainly have focused on maternal smoking, this paper factors in a larger number of maternal health...

  6. Accelerating Adverse Outcome Pathway (AOP) development via computationally predicted AOP networks

    Science.gov (United States)

    The Adverse Outcome Pathway (AOP) framework is increasingly being adopted as a tool for organizing and summarizing the mechanistic information connecting molecular perturbations by environmental stressors with adverse outcomes relevant for ecological and human health outcomes. Ho...

  7. Adverse Pregnancy Outcomes and Cardiovascular Risk Factor Management

    OpenAIRE

    Mehta, Puja K.; Minissian, Margo; Merz, C. Noel Bairey

    2015-01-01

    Cardiovascular disease (CVD) is the leading health threat to American women. In addition to established risk factors for hypertension, hyperlipidemia, diabetes, smoking, and obesity, adverse pregnancy outcomes (APOs) including pre-eclampsia, eclampsia, and gestational diabetes are now recognized as factors that increase a woman’s risk for future CVD. CVD risk factor burden is disproportionately higher in those of low socioeconomic status and in ethnic/racial minority women. Since younger wome...

  8. Antenatal psychosocial risk factors associated with adverse postpartum family outcomes.

    OpenAIRE

    Wilson, L. M.; Reid, A. J.; Midmer, D. K.; Biringer, A; Carroll, J C; Stewart, D.E.

    1996-01-01

    OBJECTIVE: To determine the strength of the association between antenatal psychosocial risk factors and adverse postpartum outcomes in the family, such as assault of women by their partner, child abuse, postpartum depression, marital dysfunction and physical illness. DATA SOURCES: MEDLINE, Cinahl, Famli, Psych Abstracts and the Oxford Database of Perinatal Trials were searched from relevant articles published from Jan. 1, 1980, to Dec. 31, 1993, with the use of MeSH terms "depression, involut...

  9. Polyhydramnios as a Predictor of Adverse Pregnancy Outcomes

    OpenAIRE

    Ilham Moosa Hamdi; Kaukab Tashfeen

    2013-01-01

    Objectives: This study aimed to ascertain the frequency of polyhydramnios in singleton pregnancies, to determine the associated risk factors, and assess the adverse maternal and perinatal outcomes. Methods: A retrospective cohort study of all singleton pregnancies complicated with polyhydramnios after 28 weeks of gestation was carried out in Nizwa Hospital’s Obstetrics & Gynecology Department, Oman, from January 2002 to December 2007. Of 25,979 pregnant women reviewed, 477 were found to have ...

  10. Maternal Serum Screening Markers and Adverse Outcome: A New Perspective

    Directory of Open Access Journals (Sweden)

    David Krantz

    2014-07-01

    Full Text Available There have been a number of studies evaluating the association of aneuploidy serum markers with adverse pregnancy outcome. More recently, the development of potential treatments for these adverse outcomes as well as the introduction of cell-free fetal DNA (cffDNA screening for aneuploidy necessitates a re-evaluation of the benefit of serum markers in the identification of adverse outcomes. Analysis of the literature indicates that the serum markers tend to perform better in identifying pregnancies at risk for the more severe but less frequent form of individual pregnancy complications rather than the more frequent but milder forms of the condition. As a result, studies which evaluate the association of biomarkers with a broad definition of a given condition may underestimate the ability of such markers to identify pregnancies that are destined to develop the more severe form of the condition. Consideration of general population screening using cffDNA solely must be weighed against the fact that traditional screening using serum markers enables detection of severe pregnancy complications, not detectable with cffDNA, of which many may be amenable to treatment options.

  11. Birth outcome measures and prenatal exposure to 4-tert-octylphenol.

    Science.gov (United States)

    Lv, Shenliang; Wu, Chunhua; Lu, Dasheng; Qi, Xiaojuan; Xu, Hao; Guo, Jianqiu; Liang, Weijiu; Chang, XiuLi; Wang, Guoquan; Zhou, Zhijun

    2016-05-01

    Exposure to 4-tert-octylphenol (tOP) has been linked with adverse health outcomes in animals and humans, while epidemiological studies about associations between prenatal exposure to tOP and fetal growth are extremely limited. We measured urinary tOP concentrations in 1100 pregnant women before their delivery, and examined whether tOP levels were associated with birth outcomes, including weight, length, head circumference and ponderal index at birth. tOP could be detected in all samples, and the median uncorrected and creatinine-corrected tOP concentrations were 0.90 μg/L (range from 0.25 to 20.05 μg/L) and 1.33 μg/g creatinine (range from 0.15 to 42.49 μg/g creatinine), respectively. Maternal urinary log-transformed tOP concentrations were significantly negatively associated with adjusted birth weight [β (g) = -126; 95% confidence interval (CI): -197, -55], birth length [β (cm) = -0.53; 95% CI:-0.93, -0.14], and head circumference [β (cm) = -0.30; 95% CI: -0.54, -0.07], respectively. Additionally, considering sex difference, these significant negative associations were also found among male neonates, while only higher maternal tOP concentrations were associated with a significant decrease in birth weight among female neonates. This study suggested significant negative associations between maternal urinary tOP concentrations and neonatal sizes at birth, and they differed by neonatal sex. Further epidemiological studies are required to more fully elaborate the associations between prenatal tOP exposure and birth outcomes. PMID:26840518

  12. Outcomes for Teenage Mothers in the First Years after Birth*

    OpenAIRE

    Guyonne Kalb; Trinh Le; Felix Leung

    2014-01-01

    This study uses data from the LSAC and HILDA surveys to examine educational, labour market, health and partnership outcomes of young women who became a mother during their teenage years and compares them with outcomes of women who became a mother in their twenties and those who do not have children yet. We find that while teenage motherhood is strongly associated with poorer outcomes in the first years after birth, a large part of the observed associations is due to selection bias. However, a...

  13. Under-attending free antenatal care is associated with adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Heinonen Seppo

    2007-09-01

    Full Text Available Abstract Background Most pertinent studies of inadequate antenatal care concentrate on the risk profile of women booking late or not booking at all to antenatal care. The objective of this study was to assess the outcome of pregnancies when free and easily accessible antenatal care has been either totally lacking or low in number of visits. Methods This is a hospital register based cohort study of pregnancies treated in Kuopio University Hospital, Finland, in 1989 – 2001. Pregnancy outcomes of women having low numbers (1–5 of antenatal care visits (n = 207 and no antenatal care visits (n = 270 were compared with women having 6–18 antenatal visits (n = 23137. Main outcome measures were: Low birth weight, fetal death, neonatal death. Adverse pregnancy outcomes were controlled for confounding factors (adjusted odds ratios, OR: s in multiple logistic regression models. Results Of the analyzed pregnant population, 1.0% had no antenatal care visits and 0.77% had 1–5 visits. Under- or non-attendance associated with social and health behavioral risk factors: unmarried status, lower educational level, young maternal age, smoking and alcohol use. Chorio-amnionitis or placental abruptions were more common complications of pregnancies of women avoiding antenatal care, and pregnancy outcome was impaired. After logistic regression analyses, controlling for confounding, there were significantly more low birth weight infants in under- and non-attenders (OR:s with 95% CI:s: 9.18 (6.65–12.68 and 5.46 (3.90–7.65, respectively more fetal deaths (OR:s 12.05 (5.95–24.40 and 5.19 (2.04–13.22, respectively and more neonatal deaths (OR:s 10.03 (3.85–26.13 and 8.66 (3.59–20.86, respectively. Conclusion Even when birth takes place in hospital, non- or under-attendance at antenatal care carries a substantially elevated risk of severe adverse pregnancy outcome. Underlying adverse health behavior and possible abuse indicate close surveillance of the

  14. Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort.

    Directory of Open Access Journals (Sweden)

    Gwinyai Masukume

    Full Text Available Anaemia in pregnancy is a major public health and economic problem worldwide, that contributes to both maternal and fetal morbidity and mortality.The aim of the study was to calculate the prevalence of anaemia in early pregnancy in a cohort of 'low risk' women participating in a large international multicentre prospective study (n = 5 609, to identify the modifiable risk factors for anaemia in pregnancy in this cohort, and to compare the birth outcomes between pregnancies with and without anaemia in early gestation.The study is an analysis of data that were collected prospectively during the Screening for Pregnancy Endpoints study. Anaemia was defined according to the World Health Organization's definition of anaemia in pregnancy (haemoglobin < 11g/dL. Binary logistic regression with adjustment for potential confounders (country, maternal age, having a marital partner, ethnic origin, years of schooling, and having paid work was the main method of analysis.The hallmark findings were the low prevalence of anaemia (2.2%, that having no marital partner was an independent risk factor for having anaemia (OR 1.34, 95% CI 1.01-1.78, and that there was no statistically significant effect of anaemia on adverse pregnancy outcomes (small for gestational age, pre-tem birth, mode of delivery, low birth weight, APGAR score < 7 at one and five minutes. Adverse pregnancy outcomes were however more common in those with anaemia than in those without.In this low risk healthy pregnant population we found a low anaemia rate. The absence of a marital partner was a non-modifiable factor, albeit one which may reflect a variety of confounding factors, that should be considered for addition to anaemia's conceptual framework of determinants. Although not statistically significant, clinically, a trend towards a higher risk of adverse pregnancy outcomes was observed in women that were anaemic in early pregnancy.

  15. Serotonin Reuptake Inhibitors in Pregnancy: Can Genes Help Us in Predicting Neonatal Adverse Outcome?

    Directory of Open Access Journals (Sweden)

    Valentina Giudici

    2014-01-01

    Full Text Available Lots has been written on use of SSRI during pregnancy and possible short and long term negative outcomes on neonates. the literature so far has described a various field of peripartum illness related to SSRI exposure during foetal life, such as increased incidence of low birth weight, respiratory distress, persistent pulmonary hypertension, poor feeding, and neurobehavioural disease. We know that different degrees of outcomes are possible, and not all the newborns exposed to SSRIs during pregnancy definitely will develop a negative outcome. So far, still little is known about the possible etiologic mechanism that could not only explain the adverse neonatal effects but also the degree of clinical involvement and presentation in the early period after birth. Pharmacogenetics and moreover pharmacogenomics, the study of specific genetic variations and their effect on drug response, are not widespread. This review describes possible relationship between SSRIs pharmacogenetics and different neonatal outcomes and summarizes the current pharmacogenetic inquiries in relation to maternal-foetal environment.

  16. Chemical respiratory allergy: Reverse engineering an adverse outcome pathway

    International Nuclear Information System (INIS)

    Allergic sensitisation of the respiratory tract by chemicals is associated with rhinitis and asthma and remains an important occupational health issue. Although less than 80 chemicals have been confirmed as respiratory allergens the adverse health effects can be serious, and in rare instances can be fatal, and there are, in addition, related socioeconomic issues. The challenges that chemical respiratory allergy pose for toxicologists are substantial. No validated methods are available for hazard identification and characterisation, and this is due in large part to the fact that there remains considerable uncertainty and debate about the mechanisms through which sensitisation of the respiratory tract is acquired. Despite that uncertainty, there is a need to establish some common understanding of the key events and processes that are involved in respiratory sensitisation to chemicals and that might in turn provide the foundations for novel approaches to safety assessment. In recent years the concept of adverse outcome pathways (AOP) has gained some considerable interest among the toxicology community as a basis for outlining the key steps leading to an adverse health outcome, while also providing a framework for focusing future research, and for developing alternative paradigms for hazard characterisation. Here we explore application of the same general principles to an examination of the induction by chemicals of respiratory sensitisation. In this instance, however, we have chosen to adopt a reverse engineering approach and to model a possible AOP for chemical respiratory allergy working backwards from the elicitation of adverse health effects to the cellular and molecular mechanisms that are implicated in the acquisition of sensitisation

  17. MOSAICISM CONFINED TO PLACENTA IN PREGNANCIES WITH ADVERSE OUTCOME

    Institute of Scientific and Technical Information of China (English)

    向阳; KarinSundberg; BjarneBeck; 孙念怙

    1995-01-01

    Chorionic villi and feral tissues from 50 pathological human conceptions ar gesrarional weeks 9-40 were cultured and cytogenetically analyzed to explore the existence of chromosomal mosaicism confined to the extraembryonic tissues and to clarify the relationship between confined placental mosaicism and adverse outcome of pregnancy. Chorionic villi and fetal rlssues from 12 second trimester gesrations terminated for social reasons served as a control group. In two pathological gestations, true mosaicism was found exclusively in chorionic cells and could not be confirmed in cells derived from the fetal tissues, One of these was severely growth retarded, Concordant results were obtained in all other cases,

  18. Frequency of Maternal and Newborn Birth Outcomes, Lima, Peru, 2013

    OpenAIRE

    Wynn, Adriane; Cabeza, Jeanne; Adachi, Kristina; Needleman, Jack; Garcia, Patricia J.; Klausner, Jeffrey D

    2015-01-01

    Objective This study describes the pregnancy and birth outcomes at two hospitals in Lima, Peru. The data collection and analysis is intended to inform patients, providers, and policy makers on Peru’s progress toward achieving the Millennium Development Goals and to help set priorities for action and further research. Methods Data were collected retrospectively from a sample of 237 women who delivered between December 2012 and September 2013 at the Instituto Nacional Materno Perinatal or the H...

  19. Fontan Outcomes and Pulmonary Blood Flow at Birth.

    Science.gov (United States)

    Evans, William N; Acherman, Ruben J; Reardon, Leigh C; Ciccolo, Michael L; Galindo, Alvaro; Rothman, Abraham; Winn, Brody J; Yumiaco, Noel S; Restrepo, Humberto

    2016-01-01

    We previously noted, in a small group of post-Fontan patients, a possible association between hepatic fibrosis scores and the status of pulmonary blood flow at birth. To further explore this observation, we examined data from all Fontan patients seen in our center from July 2010 to March 2015. We identified 200 patients for analysis. Of the 200 patients, 56 underwent transvenous-hepatic biopsy. Of the 200 patients, 13 (6.5%) had protein-losing enteropathy. We divided both the 56 biopsy patients and the entire cohort of 200 patients into 4 groups: (1) unobstructed pulmonary blood flow at birth with functional left ventricles, (2) unobstructed pulmonary blood flow at birth with functional right ventricles, (3) obstructed pulmonary blood flow at birth with functional left ventricles, and (4) obstructed pulmonary blood flow at birth with functional right ventricles. Analysis of the 56 liver-biopsy patient groups showed median hepatic total-fibrosis scores for the 4 groups of 2 (0-6), 2 (0-8), 3 (2-6), and 4 (1-8), respectively, with statistical significance between groups 4 and 1 (p = 0.031). For the entire cohort of 200 patients, we analyzed the incidence of protein-losing enteropathy for each of the four groups and found protein-losing enteropathy percent occurrences of 0, 2.9, 8.8, and 16.1, respectively, with statistical significance between groups 4 and 2 (p = 0.031) and between groups 4 and 1 (p = 0.025). A history of obstructed pulmonary blood flow at birth, coupled with a functional right ventricle, may predict a poorer long-term Fontan outcome.

  20. Association of Maternal Body Mass Index with Adverse Maternal and Prenatal Outcomes

    Directory of Open Access Journals (Sweden)

    Rahele Alijahan

    2013-09-01

    Full Text Available Background: The present study aimed to determine association between abnormal maternal body mass index and adverse maternal/prenatal outcomesMaterials and Methods: In this descriptive-correlation study 8270 pregnant women referred to rural and urban health centers of Ardabil district (from Mar 2009 to Dec 2010 were studied. Data were collected from prenatal healthcare records using a self designed questionnaire. Women with twin pregnancy, less than 18 and above 35 of age, and women with systemic or chronic disease were excluded from the study. The variables examined in this study include, demographic information (e.g. age, social and economy status, and literacy, present pregnancy information (e.g. parity, hemoglobin level, gestational diabetes, preeclampsia and prenatal information (e.g. preterm delivery, low birth weight, and congenital malformation. Data were analyzed through Kruscal wallis, chi-square, and logistic regression tests using SPSS-16.Results: Eight point two, 25 and 15.4% pregnant of women were underweight, overweight, and obese, respectively. Obese women were at increased risk for macrosomia (OR=1.820, CI: 1.345-2.447, p=0.001, unwanted pregnancy (OR= 1.436, CI: 1.198-1.720, p=0.001, pregnancy induced hypertension (OR= 1.633, CI: 1.072-2.486, p=0.022, preeclampsia (OR= 4.666, CI: 2.353-9.2550, p=0.001, and still birth (OR= 2.602, CI: 1.306-5.184, p=0.007. However, the risk of low birth weight delivery in underweight women were 1.6 times higher than the normal cases (OR= 1.674, CI: 0962-2.912, p=0.068.Conclusion: Considering high prevalence of abnormal maternal body mass index and its associated adverse maternal and prenatal outcomes; consultation before pregnancy is recommended in order to achieve normal body mass index and reduce the relevant complications.

  1. Experiences of violence before and during pregnancy and adverse pregnancy outcomes: An analysis of the Canadian Maternity Experiences Survey

    OpenAIRE

    Heaman Maureen I; O'Campo Patricia J; Urquia Marcelo L; Janssen Patricia A; Thiessen Kellie R

    2011-01-01

    Abstract Background Abuse and violence against women constitute a global public health problem and are particularly important among women of reproductive age. The literature is not conclusive regarding the impact of violence against pregnant women on adverse pregnancy outcomes, such as preterm birth, small for gestational age and postpartum depression. Most studies have been conducted on relatively small samples of high-risk women. Our objective was to investigate what dimensions of violence ...

  2. Maternal obesity and its adverse impact on labor outcome

    Directory of Open Access Journals (Sweden)

    Inas Mahmoud Hamdy

    2011-10-01

    Full Text Available Objective: to study the impact of maternal obesity on the outcome of labour. Setting: Al zahraa University hospital.Design: prospective randomized control study.Patients: a total of (80 pregnant women were included in this study from April 2009 to March 2010. Patients and Methods:According to the BMI the patients were classified into two groups. Group (I: (Control Group:Included (30 patients with (body mass index (BMI ranging from 20 to 25 kg/m2.Group (II: (Obese Group: Included (50 patients with (BMI ranging from 25 to 30kg/m2. Each patient were subjected to full clinical examination (General Abdominal and pelvic U/S pelviabdominal examination that is to confirm the inclusion and exclusion criteria of the study. Results : A significant differences was noticed between 2 groups as regard the BMI. The current study showed significant difference in cases subjected to induction of labour with p-value 0.05.No significant diff. were noticed between the 2 groups as regard the cases with Apgar score < 7 at 5 minutes with p-value 0.06. A positive correlation coefficient between the BMI (25-29, (29-33 kg/m2 with the case of induction of labour, failure to progress 1st stage, shoulder dystoca, cesarean section and fetal low Apgar score. While a negative correlation was recorded between the BMI of the control group and all the adverse outcomes. Conclusion:Obesity of the gravid women is a sensitive predictor of the adverse outcome during pregnancy, labour, and post partum. Researches are needed into effective, applicable and acceptable community -based program for obese women planning a pregnancy.

  3. A Bayesian growth mixture model to examine maternal hypertension and birth outcomes.

    Science.gov (United States)

    Neelon, Brian; Swamy, Geeta K; Burgette, Lane F; Miranda, Marie Lynn

    2011-09-30

    Maternal hypertension is a major contributor to adverse pregnancy outcomes, including preterm birth (PTB) and low birth weight (LBW). Although several studies have explored the relationship between maternal hypertension and fetal health, few have examined how the longitudinal trajectory of blood pressure, considered over the course of pregnancy, affects birth outcomes. In this paper, we propose a Bayesian growth mixture model to jointly examine the associations between longitudinal blood pressure measurements, PTB, and LBW. The model partitions women into distinct classes characterized by a mean arterial pressure (MAP) curve and joint probabilities of PTB and LBW. Each class contains a unique mixed effects model for MAP with class-specific regression coefficients and random effect covariances. To account for the strong correlation between PTB and LBW, we introduce a bivariate probit model within each class to capture residual within-class dependence between PTB and LBW. The model permits the association between PTB and LBW to vary by class, so that for some classes, PTB and LBW may be positively correlated, whereas for others, they may be uncorrelated or negatively correlated. We also allow maternal covariates to influence the class probabilities via a multinomial logit model. For posterior computation, we propose an efficient MCMC algorithm that combines full-conditional Gibbs and Metropolis steps. We apply our model to a sample of 1027 women enrolled in the Healthy Pregnancy, Healthy Baby Study, a prospective cohort study of host, social, and environmental contributors to disparities in pregnancy outcomes. PMID:21751226

  4. PREVALENCE OF PHYSICAL VIOLENCE AGAINST PREGNANT WOMEN AND EFFECTS ON MATERNAL AND BIRTH OUTCOMES

    Directory of Open Access Journals (Sweden)

    M. Nojomi Z. Akrami

    2006-06-01

    Full Text Available Violence and the threat of violence against pregnant women are main barriers to women’s empowerment and equal participation in society. When stress and violence increase in developing societies, women’s safety in the home, workplace and community is often seriously affected. To determine the prevalence of physical abuse in pregnant women and to assess association between physical violence during pregnancy and maternal complications and birth outcomes, we used clinicbased data from a sample of 403 women who delivered live born infants during the summer of 2002 in our hospital. Data of physical violence against women’s during pregnancy and 3 months before that were based on questionnaire and interview. Outcomes data including antenatal hospitalization, labor and delivery complications were obtained from the records. Prevalence of physical violence during pregnancy was reported as 10.7%. Prevalence of experience of physical abuse 3 months before pregnancy was 11.9%. Women who experienced physical violence compared with those not reporting abuse were more likely to be smoker and hospitalized before delivery for maternal complications such as preterm labor, kidney infections, premature rupture of membranes and vaginal bleeding with pain. There was a significant association between physical violence and low birth weight and mother’s education. Physical violence during pregnancy is common and is associated with maternal complications and adverse birth outcomes. We suggest including methods to determine frequency of violence during pregnancy and assessment of violence in pregnancy by a screening program integrated in prenatal care.

  5. Excessive folic acid intake and relation to adverse health outcome.

    Science.gov (United States)

    Selhub, Jacob; Rosenberg, Irwin H

    2016-07-01

    The recent increase in the intake of folic acid by the general public through fortified foods and supplements, has raised safety concern based on early reports of adverse health outcome in elderly with low B12 status who took high doses of folic acid. These safety concerns are contrary to the 2015 WHO statement that "high folic acid intake has not reliably been shown to be associated with negative healeffects". In the folic acid post-fortification era, we have shown that in elderly participants in NHANES 1999-2002, high plasma folate level is associated with exacerbation of both clinical (anemia and cognitive impairment) and biochemical (high MMA and high Hcy plasma levels) signs of vitamin B12 deficiency. Adverse clinical outcomes in association with high folate intake were also seen among elderly with low plasma B12 levels from the Framingham Original Cohort and in a study from Australia which combined three elderly cohorts. Relation between high folate and adverse biochemical outcomes were also seen in the Sacramento Area Latino Study on Aging (High Hcy, high MMA and lower TC2) and at an outpatient clinic at Yale University where high folate is associated with higher MMA in the elderly but not in the young. Potential detrimental effects of high folic acid intake may not be limited to the elderly nor to those with B12 deficiency. A study from India linked maternal high RBC folate to increased insulin resistance in offspring. Our study suggested that excessive folic acid intake is associated with lower natural killer cells activity in elderly women. In a recent study we found that the risk for unilateral retinoblastoma in offspring is 4 fold higher in women that are homozygotes for the 19 bp deletion in the DHFR gene and took folic acid supplement during pregnancy. In the elderly this polymorphism is associated with lower memory and executive scores, both being significantly worse in those with high plasma folate. These and other data strongly imply that

  6. Pre-existing diabetes mellitus and adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Wahabi Hayfaa A

    2012-09-01

    Full Text Available Abstract Background Pregnancies complicated by pre-existing diabetes mellitus (PDM are associated with a high rate of adverse outcomes, including an increased miscarriage rate, preterm delivery, preeclampsia, perinatal mortality and congenital malformations; compared to the background population. The objectives of this study are to determine the prevalence of PDM and to investigate the maternal and the neonatal outcomes of women with PDM. Methods This is a retrospective cohort study for women who delivered in King Khalid University Hospital (KKUH during the period of January 1st to the 31st of December 2008. The pregnancy outcomes of the women with PDM were compared to the outcomes of all non-diabetic women who delivered during the same study period. Results A total of 3157 deliveries met the inclusion criteria. Out of the study population 116 (3.7% women had PDM. There were 66 (57% women with type 1 diabetes mellitus (T1DM and 50 (43% women with type 2 diabetes mellitus (T2DM. Compared to non-diabetic women those with PDM were significantly older, of higher parity, and they had more previous miscarriages. Women with PDM were more likely to be delivered by emergency cesarean section (C/S, OR 2.67, 95% confidence intervals (CI (1.63-4.32, P P P P = 0.002. They more frequently have APGAR scores P 0.057 and more likely to be delivered at P 0.003. The stillbirth rate was 2.6 times more among the women with PDM; however the difference did not reach statistical significance, P 0.084. Conclusion PDM is associated with increased risk for C/S delivery, macrosomia, stillbirth, preterm delivery and low APGAR scores at 5 min.

  7. Birth Outcomes across Three Rural-Urban Typologies in the Finger Lakes Region of New York

    Science.gov (United States)

    Strutz, Kelly L.; Dozier, Ann M.; van Wijngaarden, Edwin; Glantz, J. Christopher

    2012-01-01

    Purpose: The study is a descriptive, population-based analysis of birth outcomes in the New York State Finger Lakes region designed to determine whether perinatal outcomes differed across 3 rural typologies. Methods: Hospital birth data for the Finger Lakes region from 2006 to 2007 were used to identify births classified as low birthweight (LBW),…

  8. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort.

    Directory of Open Access Journals (Sweden)

    Louise C Kenny

    Full Text Available BACKGROUND: Recent decades have witnessed an increase in mean maternal age at childbirth in most high-resourced countries. Advanced maternal age has been associated with several adverse maternal and perinatal outcomes. Although there are many studies on this topic, data from large contemporary population-based cohorts that controls for demographic variables known to influence perinatal outcomes is limited. METHODS: We performed a population-based cohort study using data on all singleton births in 2004-2008 from the North Western Perinatal Survey based at The University of Manchester, UK. We compared pregnancy outcomes in women aged 30-34, 35-39 and ≥40 years with women aged 20-29 years using log-linear binomial regression. Models were adjusted for parity, ethnicity, social deprivation score and body mass index. RESULTS: The final study cohort consisted of 215,344 births; 122,307 mothers (54.19% were aged 20-29 years, 62,371(27.63% were aged 30-34 years, 33,966(15.05% were aged 35-39 years and 7,066(3.13% were aged ≥40 years. Women aged 40+ at delivery were at increased risk of stillbirth (RR = 1.83, [95% CI 1.37-2.43], pre-term (RR = 1.25, [95% CI: 1.14-1.36] and very pre-term birth (RR = 1.29, [95% CI:1.08-1.55], Macrosomia (RR = 1.31, [95% CI: 1.12-1.54], extremely large for gestational age (RR = 1.40, [95% CI: 1.25-1.58] and Caesarean delivery (RR = 1.83, [95% CI: 1.77-1.90]. CONCLUSIONS: Advanced maternal age is associated with a range of adverse pregnancy outcomes. These risks are independent of parity and remain after adjusting for the ameliorating effects of higher socioeconomic status. The data from this large contemporary cohort will be of interest to healthcare providers and women and will facilitate evidence based counselling of older expectant mothers.

  9. Adolescence as risk factor for adverse pregnancy outcome in Central Africa--a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Florian Kurth

    Full Text Available BACKGROUND: Sub-Saharan Africa has the highest rates of maternal and neonatal mortality worldwide. Young maternal age at delivery has been proposed as risk factor for adverse pregnancy outcome, yet there is insufficient data from Sub-Saharan Africa. The present study aimed to investigate the influence of maternal adolescence on pregnancy outcomes in the Central African country Gabon. METHODOLOGY AND PRINCIPAL FINDINGS: Data on maternal age, parity, birth weight, gestational age, maternal Plasmodium falciparum infection, use of bednets, and intake of intermittent preventive treatment of malaria in pregnancy were collected in a cross-sectional survey in 775 women giving birth in three mother-child health centers in Gabon. Adolescent women (≤16 years of age had a significantly increased risk to deliver a baby with low birth weight in univariable analysis (22.8%, 13/57, vs. 9.3%, 67/718, OR: 2.9, 95% CI: 1.5-5.6 and young maternal age showed a statistically significant association with the risk for low birth weight in multivariable regression analysis after correction for established risk factors (OR: 2.7; 95% CI: 1.1-6.5. In further analysis adolescent women were shown to attend significantly less antenatal care visits than adult mothers (3.3±1.9 versus 4.4±1.9 mean visits, p<0.01, n = 356 and this difference accounted at least for part of the excess risk for low birth weight in adolescents. CONCLUSION: Our data demonstrate the importance of adolescent age as risk factor for adverse pregnancy outcome. Antenatal care programs specifically tailored for the needs of adolescents may be necessary to improve the frequency of antenatal care visits and pregnancy outcomes in this risk group in Central Africa.

  10. Clinical outcomes and adverse effect monitoring in allergic rhinitis.

    Science.gov (United States)

    Juniper, Elizabeth F; Ståhl, Elisabeth; Doty, Richard L; Simons, F Estelle R; Allen, David B; Howarth, Peter H

    2005-03-01

    The subjective recording in diary cards of symptoms of itch, sneeze, nose running, and blockage, with the use of a rating scale to indicate the level of severity, is usual for clinical trials in allergic rhinitis. The primary outcome measure is usually a composite score that enables a single total symptoms score endpoint. It is appreciated, however, that rhinitis has a greater effect on the individual than is reflected purely by the recording of anterior nasal symptoms. Nasal obstruction is troublesome and may lead to sleep disturbance in addition to impaired daytime concentration and daytime sleepiness. These impairments affect school and work performance. Individuals with rhinitis find it socially embarrassing to be seen sneezing, sniffing, or blowing their nose. To capture these and other aspects of the disease-specific health-related quality of life, questionnaires such as the Rhinoconjunctivitis Quality of Life Questionnaire have been developed and validated for clinical trial use. The adoption of health-related quality of life questionnaires into clinical trials broadens the information obtained regarding the effect of the therapeutic intervention and helps focus on issues relevant to the individual patient. It must be appreciated that it is not only the disease that may adversely affect health-related quality of life; administered therapy, although intended to be beneficial, may also cause health impairment. Adverse-event monitoring is thus essential in clinical trials. The first-generation H 1 -histamines, because of their effect on central H 1 -receptors, are classically associated with central nervous system (CNS) effects such as sedation. Although this is not always perceived by the patient, it is clearly evident with objective performance testing, and positron emission tomography scanning has directly demonstrated the central H 1 -receptor occupancy. The second-generation H 1 -antihistamines have reduced central H 1 -receptor occupancy and considerably

  11. Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes

    Directory of Open Access Journals (Sweden)

    Yakoob Mohammad

    2011-04-01

    Full Text Available Abstract Objectives/background Given the widespread prevalence of micronutrient deficiencies in developing countries, supplementation with multiple micronutrients rather than iron-folate alone, could be of potential benefit to the mother and the fetus. These benefits could relate to prevention of maternal complications and reduction in other adverse pregnancy outcomes such as small-for-gestational age (SGA births, low birth weight, stillbirths, perinatal and neonatal mortality. This review evaluates the evidence of the impact of multiple micronutrient supplements during pregnancy, in comparison with standard iron-folate supplements, on specific maternal and pregnancy outcomes of relevance to the Lives Saved Tool (LiST. Data sources/review methods A systematic review of randomized controlled trials was conducted. Search engines used were PubMed, the Cochrane Library, the WHO regional databases and hand search of bibliographies. A standardized data abstraction and Child Health Epidemiology Reference (CHERG adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE technique were used for data abstraction and overall quality of evidence. Meta-analyses were performed to calculate summary estimates of utility to the LiST model for the specified outcome of incidence of SGA births. We also evaluated the potential impact of multiple micronutrients on neonatal mortality according to the proportion of deliveries occurring in facilities (using a threshold of 60% to indicate functionality of health systems for skilled births. Results We included 17 studies for detailed data abstraction. There was no significant benefit of multiple micronutrients as compared to iron folate on maternal anemia in third trimester [Relative risk (RR = 1.03; 95% confidence interval (CI: 0.87 – 1.22 (random model]. Our analysis, however, showed a significant reduction in SGA by 9% [RR = 0.91; 95% CI: 0.86 – 0.96 (fixed model]. In the fixed model

  12. Adverse pregnancy outcomes and cardiovascular risk factor management.

    Science.gov (United States)

    Mehta, Puja K; Minissian, Margo; Bairey Merz, C Noel

    2015-06-01

    Cardiovascular disease (CVD) is the leading health threat to American women. In addition to establish risk factors for hypertension, hyperlipidemia, diabetes, smoking, and obesity, adverse pregnancy outcomes (APOs) including pre-eclampsia, eclampsia, and gestational diabetes are now recognized as factors that increase a woman's risk for future CVD. CVD risk factor burden is disproportionately higher in those of low socioeconomic status and in ethnic/racial minority women. Since younger women often use their obstetrician/gynecologist as their primary health provider, this is an opportune time to diagnose and treat CVD risk factors early. Embedding preventive care providers such as nurse practitioners or physician assistants within OB/GYN practices can be considered, with referral to family medicine or internist for ongoing risk assessment and management. The American Heart Association (AHA)/American Stroke Association (ASA) stroke prevention guidelines tailored to women recommend that women with a history of pre-eclampsia can be evaluated for hypertension and other CVD risk factors within 6 months to 1-year post-partum. Given the burden and impact of CVD on women in our society, the entire medical community must work to establish feasible practice and referral patterns for assessment and treatment of CVD risk factors.

  13. Nursing Student Birth Doulas' Influence On the Childbearing Outcomes of Vulnerable Populations.

    Science.gov (United States)

    Van Zandt, Shirley E; Kim, Soohyun; Erickson, Amanda

    2016-01-01

    Of 1,511 women served by nursing student birth doulas (Birth Companions) between 1998 and 2014, 34.5% were identified as vulnerable (refugees, non-English speakers, teens, low income, low education). This retrospective evaluation of the Birth Companions Program showed that vulnerable mothers had more epidurals and smaller babies, and attempted breastfeeding less frequently than nonvulnerable. There was no difference in the frequency of caesarean births, pitocin induction/augmentation, low birth weight, or preterm newborns among the vulnerable women. Birth Companion interventions may have a role in influencing these outcomes. The Birth Companions program will use this analysis to identify additional services for these populations. PMID:27383776

  14. Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis

    Science.gov (United States)

    Simmonds, Mark; Bryant, Maria; Sheldon, Trevor A; Tuffnell, Derek; Golder, Su; Dunne, Fidelma; Lawlor, Debbie A

    2016-01-01

    Objectives To assess the association between maternal glucose concentrations and adverse perinatal outcomes in women without gestational or existing diabetes and to determine whether clear thresholds for identifying women at risk of perinatal outcomes can be identified. Design Systematic review and meta-analysis of prospective cohort studies and control arms of randomised trials. Data sources Databases including Medline and Embase were searched up to October 2014 and combined with individual participant data from two additional birth cohorts. Eligibility criteria for selecting studies Studies including pregnant women with oral glucose tolerance (OGTT) or challenge (OGCT) test results, with data on at least one adverse perinatal outcome. Appraisal and data extraction Glucose test results were extracted for OGCT (50 g) and OGTT (75 g and 100 g) at fasting and one and two hour post-load timings. Data were extracted on induction of labour; caesarean and instrumental delivery; pregnancy induced hypertension; pre-eclampsia; macrosomia; large for gestational age; preterm birth; birth injury; and neonatal hypoglycaemia. Risk of bias was assessed with a modified version of the critical appraisal skills programme and quality in prognostic studies tools. Results 25 reports from 23 published studies and two individual participant data cohorts were included, with up to 207 172 women (numbers varied by the test and outcome analysed in the meta-analyses). Overall most studies were judged as having a low risk of bias. There were positive linear associations with caesarean section, induction of labour, large for gestational age, macrosomia, and shoulder dystocia for all glucose exposures across the distribution of glucose concentrations. There was no clear evidence of a threshold effect. In general, associations were stronger for fasting concentration than for post-load concentration. For example, the odds ratios for large for gestational age per 1 mmol/L increase of

  15. From places to flows. International secondary migration and birth outcomes.

    Science.gov (United States)

    Urquia, Marcelo L; Frank, John W; Glazier, Richard H

    2010-11-01

    Research on the health status of international migrants to industrialised countries in general, and on perinatal outcomes in particular, has assumed an interpretative model based on primary migration, characterised by one permanent cross-border movement from the migrant's country of birth. However, many migrants experience more complex migration patterns that may also be associated with human health. Secondary migration, defined as a migration from a country of residence other than the country where the immigrant was born, has been growing during the last two decades, favoured by globalisation. The purpose of this study was to examine the association between secondary migration and preterm birth (PTB) and infant birthweight at term (BW) using a Canadian official immigration database to build a cohort of immigrants to Ontario, Canada, who obtained their permanent residence in the years 1985-2000. The study population comprised 320,398 singleton live infants born to immigrant women during 1988-2007. Primary and secondary migrants were categorised according to whether they were born in an industrialised country or not. Secondary migrants were further subdivided according to whether the country from which they migrated to Canada was industrialised or not. We found that compared to primary migrants, secondary migrants to Canada born in non-industrialised countries had lower odds of PTB and higher mean BW at term. However, such a protective effect was not observed among secondary migrants born in industrialised countries. In a cross-classified multilevel model restricted to secondary migrants, 5.2% of the variation in birthweight was explained by migrants' countries of birth and 0.8% by migrants' countries of last permanent residence. These findings are consistent with the so-called healthy migrant effect, implying that selective migration from non-industrialised countries is associated with protective individual characteristics. PMID:20850920

  16. Frequency of maternal and newborn birth outcomes, Lima, Peru, 2013.

    Directory of Open Access Journals (Sweden)

    Adriane Wynn

    Full Text Available This study describes the pregnancy and birth outcomes at two hospitals in Lima, Peru. The data collection and analysis is intended to inform patients, providers, and policy makers on Peru's progress toward achieving the Millennium Development Goals and to help set priorities for action and further research.Data were collected retrospectively from a sample of 237 women who delivered between December 2012 and September 2013 at the Instituto Nacional Materno Perinatal or the Hospital Nacional Arzobispo Loayza. The outcomes were recorded by a trained mid-wife through telephone interviews with patients and by review of hospital records. Associations between participant demographic characteristics and pregnancy outcomes were tested with Chi-squared, Fisher's exact, or Student's t-test.Over 37% of women experienced at least one maternal or perinatal complication, and the most frequent were hypertension/preeclampsia and macrosomia. The women in our sample had a cesarean section rate of 50.2%.Maternal and perinatal complications are not uncommon among women in the lower socioeconomic strata of Lima. Also, the high cesarean rate underpins the need for a more comprehensive understanding of the indications for cesarean section deliveries, which could help reduce the number of unnecessary procedures and preventable complications.

  17. Population-based investigations to study the association of cardiovascular polymorphisms and adverse pregnancy outcome

    DEFF Research Database (Denmark)

    Lykke, Jacob Alexander; Langhoff-Roos, Jens; Young, Bradford;

    2007-01-01

    Adverse pregnancy outcome refers to placenta-mediated complications that may share a common etiopathogenesis in some cases. Unraveling associations between prothrombotic genetic predispositions and these pregnancy disorders, namely recurrent fetal loss, stillbirth, severe preeclampsia, intrauterine...... study focuses on pro-thrombotic and cardiovascular genetic polymorphisms in a nested-case control study comparing pregnancies with and without an adverse pregnancy outcome in the index pregnancy. This study will be adequately powered to determine the relationship between adverse pregnancy outcome and...

  18. Adverse pregnancy outcomes and subsequent risk of cardiovascular disease in women with systemic lupus erythematosus

    OpenAIRE

    Lin, Pin; Rhew, Elisa; Ness, Roberta B.; PEACEMAN, Alan; Dyer, Alan; McPherson, David; Kondos, George T.; Edmundowicz, Daniel; Sutton-Tyrrell, Kim; Thompson, Trina; Ramsey-Goldman, Rosalind

    2014-01-01

    Background/objective Patients with systemic lupus erythematosus (SLE) are at increased risk for adverse pregnancy outcomes and cardiovascular disease (CVD). The objective of this exploratory study was to investigate the association between a history of adverse pregnancy outcomes and subsequent risk of subclinical CVD assessed by imaging studies and verified clinical CVD events in 129 women with SLE. Methods The occurrence of adverse pregnancy outcomes, specifically pre-eclampsia, preterm birt...

  19. Integration of umbilical venous and arterial Doppler flow parameters for prediction of adverse perinatal outcome

    Directory of Open Access Journals (Sweden)

    Hebbar Shripad

    2015-01-01

    Full Text Available Background: Quantification of umbilical vein (UV blood flow rate and umbilical artery Doppler indices might be valuable in assessing fetuses at increased risk of perinatal complications as they receive their supply of oxygen and nutrients through this vessel. Previous studies have indicated that UV blood volume flow rate to umbilical artery pulsatility index (UAPI ratio (venous arterial index [VAI] evaluates both venous and arterial arm of fetal umbilical circulation and hence, can be adopted as a screening tool in management of high risk pregnancy. Objectives: To compare umbilical VAI with adverse perinatal outcome and also to evaluate its efficacy with other flow indices in determining perinatal outcome. Materials and Methods: Various Doppler indices such as normalized blood flow rate in UV (nUV, ml/kg estimated fetal weight/min, VAI (nUV/UAPI, umbilical artery resistance index (RI, UAPI, and systolic diastolic ratio were determined in 103 pregnant women within 2 weeks of the delivery. A risk score was devised using APGAR at 5 min, birth weight, preterm delivery, fetal distress, Neonatal Intensive Care Unit (NICU care, and perinatal death and this score was correlated with antenatal Doppler findings. Results: Subjects with low VAI were found to have a greater association with intrauterine growth restricted fetuses (28.5% and low liquor (35.7%, preterm deliveries (46.4%, lower mean birth weight (2.25 kg, higher NICU admission rates (32.1%. The unfavorable score was noticed in 25.2% of the neonates. They had lower VAI (156 vs. 241, UV diameter (6.2 mm vs. 7.8 mm, UV velocity (16.2 vs. 17.8, nUV (163.7 vs. 206.4, and higher PI (1.3 vs. 0.9. A cut-off of VAI of 105 ml/kg/min had sensitivity of 86.7% and a specificity of 93.5% for predicting poor perinatal outcome. Conclusion: VAI with a cut-off of 105 ml/kg/min can be used as an additional tool along with the other conventional Doppler indices in order to predict adverse fetal outcome.

  20. β-Blocker treatment during pregnancy and adverse pregnancy outcomes

    DEFF Research Database (Denmark)

    Petersen, Kasper Meidahl; Jimenez-Solem, Espen; Andersen, Jon Traerup;

    2012-01-01

    To investigate the association between exposure to β-blockers during pregnancy and the risk of being born small for gestational age (SGA), preterm birth and perinatal mortality in a nationwide cohort.......To investigate the association between exposure to β-blockers during pregnancy and the risk of being born small for gestational age (SGA), preterm birth and perinatal mortality in a nationwide cohort....

  1. Occupational exposure to pesticides and pregnancy outcomes in gardeners and farmers: a study within the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Zhu, Jin Liang; Hjøllund, Niels Henrik Ingvar; Andersen, AM;

    2006-01-01

    regression was applied to analyze late fetal loss and congenital malformations, and logistic regression was used to analyze preterm birth and small for gestational age. RESULTS: There were no significant differences in the studied pregnancy outcomes between gardeners or farmers and all other workers, except......OBJECTIVE: We conducted a follow-up study to examine whether exposure to pesticides during pregnancy had an adverse effect on pregnancy outcomes among Danish gardeners and farmers. METHODS: Using data from the National Birth Cohort in Denmark, we identified 226 pregnancies of gardeners and 214...... pregnancies of farmers during 1997 through 2003. Work activities and exposure to pesticides were reported in an interview (around 16 weeks of gestation). Totally, 62,164 other workers in the cohort served as a reference group. Pregnancy outcomes were obtained by linkage to the national registers. Cox...

  2. Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery.

    LENUS (Irish Health Repository)

    McKenny, M

    2011-05-01

    This study investigated the hypothesis that storage age of transfused red blood cells (RBCs) is associated with adverse outcome after cardiac surgery, and examined association between volume of RBC transfusions and outcome after cardiac surgery.

  3. Planned Repeat Cesarean Section at Term and Adverse Childhood Health Outcomes: A Record-Linkage Study.

    Directory of Open Access Journals (Sweden)

    Mairead Black

    2016-03-01

    Full Text Available Global cesarean section (CS rates range from 1% to 52%, with a previous CS being the commonest indication. Labour following a previous CS carries risk of scar rupture, with potential for offspring hypoxic brain injury, leading to high rates of repeat elective CS. However, the effect of delivery by CS on long-term outcomes in children is unclear. Increasing evidence suggests that in avoiding exposure to maternal bowel flora during labour or vaginal birth, offspring delivered by CS may be adversely affected in terms of energy uptake from the gut and immune development, increasing obesity and asthma risks, respectively. This study aimed to address the evidence gap on long-term childhood outcomes following repeat CS by comparing adverse childhood health outcomes after (1 planned repeat CS and (2 unscheduled repeat CS with those that follow vaginal birth after CS (VBAC.A data-linkage cohort study was performed. All second-born, term, singleton offspring delivered between 1 January 1993 and 31 December 2007 in Scotland, UK, to women with a history of CS (n = 40,145 were followed up until 31 January 2015. Outcomes assessed included obesity at age 5 y, hospitalisation with asthma, learning disability, cerebral palsy, and death. Cox regression and binary logistic regression were used as appropriate to compare outcomes following planned repeat CS (n = 17,919 and unscheduled repeat CS (n = 8,847 with those following VBAC (n = 13,379. Risk of hospitalisation with asthma was greater following both unscheduled repeat CS (3.7% versus 3.3%, adjusted hazard ratio [HR] 1.18, 95% CI 1.05-1.33 and planned repeat CS (3.6% versus 3.3%, adjusted HR 1.24, 95% CI 1.09-1.42 compared with VBAC. Learning disability and death were more common following unscheduled repeat CS compared with VBAC (3.7% versus 2.3%, adjusted odds ratio 1.64, 95% CI 1.17-2.29, and 0.5% versus 0.4%, adjusted HR 1.50, 95% CI 1.00-2.25, respectively. Risk of obesity at age 5 y and risk of cerebral

  4. Recent immigration and adverse pregnancy outcomes in an urban setting in Spain.

    Science.gov (United States)

    Garcia-Subirats, Irene; Pérez, Glòria; Rodríguez-Sanz, Maica; Salvador, Joaquín; Jané, Mireia

    2011-07-01

    To describe social and economic inequalities in non-fatal pregnancy outcomes (low birth weight, preterm birth and small for gestational age births) in the neighbourhoods of the city of Barcelona (Spain), according to maternal age and maternal country of origin, between 1991 and 2005. A cross-sectional ecological study was carried out using the 38 neighbourhoods of Barcelona as the unit of analysis. The study population comprises the 192,921 live births to resident women aged 12-49 residing from 1991 to 2005. Information was gathered from births registry. Prevalence of low birth-weight, preterm birth and small for gestational age, was calculated for each of the 38 neighbourhoods of mothers' residence, stratifying results by maternal age and country of origin. The indicator of neighbourhood socio-economic level was the unemployment rate. Quartile maps along with Spearman correlation coefficients and linear regression were performed between indicators. The present study reports socio-economic inequalities in pregnancy outcomes among neighbourhoods in Barcelona (Spain): the more disadvantaged neighbourhoods have worse pregnancy outcomes (low birth weight, preterm birth and small for gestational age births) in all women age groups. These inequalities do not exist among immigrant women, and some groups of foreign mothers even have lower rates of low birth weight, preterm birth, and small for gestational age births than autochthonous women. The existing inequalities suggest that policy efforts to reduce these inequalities are not entirely successful and should focus on improving pregnancy and delivery care in less privileged women in a country with universal access to health care. PMID:20440546

  5. Evaluation of hypothesized adverse outcome pathway linking thyroid peroxidase inhibition to fish early life stage toxicity

    Science.gov (United States)

    There is an interest in developing alternatives to the fish early-life stage (FELS) test (OECD test guideline 210), for predicting adverse outcomes (e.g., impacts on growth and survival) using less resource-intensive methods. Development and characterization of adverse outcome pa...

  6. Maternal obesity in early pregnancy and risk of adverse outcomes.

    Directory of Open Access Journals (Sweden)

    Inmaculada Bautista-Castaño

    Full Text Available OBJECTIVES: To assess the role of the health consequences of maternal overweight and obesity at the start of pregnancy on gestational pathologies, delivery and newborn characteristics. METHODS: A cohort of pregnant women (n = 6.558 having delivered at the Maternal & Child University Hospital of Gran Canaria (HUMIGC in 2008 has been studied. Outcomes were compared using multivariate analyses controlling for confounding variables. RESULTS: Compared to normoweight, overweight and obese women have greater risks of gestational diabetes mellitus (RR = 2.13 (95% CI: 1.52-2.98 and (RR = 2.85 (95% CI: 2.01-4.04, gestational hypertension (RR = 2.01 (95% CI: 1.27-3.19 and (RR = 4.79 (95% CI: 3.13-7.32 and preeclampsia (RR = 3.16 (95% CI: 1.12-8.91 and (RR = 8.80 (95% CI: 3.46-22.40. Obese women have also more frequently oligodramnios (RR = 2.02 (95% CI: 1.25-3.27, polyhydramnios. (RR = 1.76 (95% CI: 1.03-2.99, tearing (RR = 1.24 (95% CI: 1.05-1.46 and a lower risk of induced deliveries (RR = 0.83 (95% CI: 0.72-0.95. Both groups have more frequently caesarean section (RR = 1.36 (95% CI: 1.14-1.63 and (RR = 1.84 (95% CI: 1.53-2.22 and manual placenta extraction (RR = 1.65 (95% CI: 1.28-2.11 and (RR = 1.77 (95% CI: 1.35-2.33. Newborns from overweight and obese women have higher weight (p<0.001 and a greater risk of being macrosomic (RR = 2.00 (95% CI: 1.56-2.56 and (RR = 2.74 (95% CI: 2.12-3.54. Finally, neonates from obese mother have a higher risk of being admitted to special care units (RR = 1.34 (95% CI: 1.01-1.77. Apgar 1 min was significantly higher in newborns from normoweight mothers: 8.65 (95% CI: 8.62-8.69 than from overweight: 8.56 (95% CI: 8.50-8.61 or obese mothers: 8.48 (95% CI: 8.41-8.54. CONCLUSION: Obesity and overweight status at the beginning of pregnancy increase the adverse outcomes of the pregnancy. It is important to promote the normalization of bodyweight in those

  7. Saving Lives at Birth : The Impact of Home Births on Infant Outcomes

    NARCIS (Netherlands)

    Meltem Daysal, N.; Trandafir, M.; van Ewijk, R.

    2012-01-01

    Abstract: Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for endogene

  8. Organ-specific systemic lupus erythematosus activity during pregnancy is associated with adverse pregnancy outcomes.

    Science.gov (United States)

    Tedeschi, Sara K; Guan, Hongshu; Fine, Alexander; Costenbader, Karen H; Bermas, Bonnie

    2016-07-01

    Systemic lupus erythematosus (SLE) is a disease of reproductive-age women, and thus questions regarding how disease influences pregnancy outcomes arise. We investigated whether five specific types of SLE activity during the 6 months before conception or during pregnancy (nephritis, cytopenias, skin disease, arthritis, serositis) were associated with adverse pregnancy outcomes. We performed a retrospective cohort study of pregnancy outcomes among women with SLE at the Brigham and Women's Hospital Lupus Center. Adverse pregnancy outcomes included pre-eclampsia, pre-term delivery, elective termination due to SLE, spontaneous miscarriage at weeks 12-20, and stillbirth. SLE and obstetric history, laboratories, and medications were obtained from electronic medical records. Generalized linear mixed models adjusting for potential confounders were used to identify predictors of any adverse pregnancy outcome. Most pregnancies resulted in a live term delivery (76.5 %). After adjustment for Hispanic ethnicity, prior adverse pregnancy outcome and medication use 6 months before conception, nephritis during pregnancy (odds ratio (OR) 3.6, 95 % confidence interval (CI) 1.0-12.8), cytopenias during pregnancy (OR 3.9, 95 % CI 1.3-11.4), and serositis during pregnancy (OR 5.9, 95 % CI 1.0-34.0) were significantly associated with adverse pregnancy outcome. Specific types of SLE disease activity during pregnancy were related to adverse pregnancy outcome. Nephritis, cytopenias, and serositis carried a higher risk of adverse pregnancy outcome, suggesting that these abnormalities should be carefully monitored during pregnancy. PMID:27166627

  9. Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Bijaya K Padhi

    2015-07-01

    Full Text Available The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs. We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India.A prospective cohort of pregnant women (n = 670 in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation. A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs and adjusted odds ratios (AORs and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4% preterm births, 95 (14.2% births with low birth weight, 11 (1.7% spontaneous abortions, and six (0.9% stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72-3.71, preterm birth (OR: 2.36; 95% CI: 1.54-3.62, and low birth weight (OR: 2.00; 95% CI: 1.24-3.23 were found to be significantly associated with open defecation practices. After adjustment for potential confounders such as maternal socio-demographic and clinical factors, open defecation was still significantly associated with increased odds of APOs (AOR: 2.38; 95% CI: 1.49-3.80 and preterm birth (AOR: 2.22; 95% CI: 1.29-3.79 but not low birth weight (AOR: 1.61; 95% CI: 0.94-2.73. The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the

  10. INCOME INCONGRUITY, RACE AND PRETERM BIRTH

    Science.gov (United States)

    Previous research with vital records finds income incongruity associated with adverse birth outcomes. We examined the effects of negative income incongruity (reporting lower household income than the census tract median household income) on preterm birth (PTB <37 weeks completed ...

  11. INCOME INCONGRUITY, RACE AND PRETERM BIRTH (PTB)

    Science.gov (United States)

    Previous research using birth records has found income incongruity associated with adverse birth outcomes. The effects of negative income incongruity (reporting lower household income than the census tract median household income) on PTB (<37 weeks completed gestation) are examin...

  12. Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study

    Directory of Open Access Journals (Sweden)

    Nastassja Koen

    2016-02-01

    Full Text Available Background: Prenatal and peripartum trauma may be associated with poor maternal–fetal outcomes. However, relatively few data on these associations exist from low-middle income countries, and populations in transition. Objective: We investigated the prevalence and risk factors for maternal trauma and posttraumatic stress disorder (PTSD, and their association with adverse birth outcomes in the Drakenstein Child Health Study, a South African birth cohort study. Methods: Pregnant women were recruited from two clinics in a peri-urban community outside Cape Town. Trauma exposure and PTSD were assessed using diagnostic interviews; validated self-report questionnaires measured other psychosocial characteristics. Gestational age at delivery was calculated and birth outcomes were assessed by trained staff. Multiple logistic regression explored risk factors for trauma and PTSD; associations with birth outcomes were investigated using linear regression. Potential confounders included study site, socioeconomic status (SES, and depression. Results: A total of 544 mother–infant dyads were included. Lifetime trauma was reported in approximately two-thirds of mothers, with about a third exposed to past-year intimate partner violence (IPV. The prevalence of current/lifetime PTSD was 19%. In multiple logistic regression, recent life stressors were significantly associated with lifetime trauma, when controlling for SES, study site, and recent IPV. Childhood trauma and recent stressors were significantly associated with PTSD, controlling for SES and study site. While no association was observed between maternal PTSD and birth outcomes, maternal trauma was significantly associated with a 0.3 unit reduction (95% CI: 0.1; 0.5 in infant head-circumference-for-age z-scores (HCAZ scores at birth in crude analysis, which remained significant when adjusted for study site and recent stressors in a multivariate regression model. Conclusions: In this exploratory study

  13. ADVERSE MATERNAL AND PERINATAL OUTCOMES IN GESTATIONAL DIABETES MELLITUS

    OpenAIRE

    Ambarisha Bhandiwad, Divyasree B, Surakshith L Gowda

    2015-01-01

    Introduction: Women with Gestational Diabetes Mellitus (GDM) are at increased risk for many other health concerns with short and long-term implications for both mother and child. They are at higher risk for glucose-mediated macrosomia, hypertension, birth trauma, respiratory distress, hypoglycemia, hyperbilirubinemia with increased neonatal intensive care unit (NICU) admissions. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovas...

  14. Adult outcomes of teen mothers across birth cohorts

    OpenAIRE

    Anne Driscoll

    2014-01-01

    Background: Teen and young adult mothers have lower socioeconomic status than older mothers. Objective: This study analyzes the socioeconomic status (SES) of teen, young adult, and older adult mothers across four five-year birth cohorts from 1956 to 1975 who were teens from 1971 to 1994. Methods: Data were pooled from the 1995, 2002, and 2006-2010 National Survey of Family Growth (NSFG). Mothers were categorized by age at first birth and by their birth cohorts. The SES (education, singl...

  15. Preterm prelabor rupture of membranes and outcome of very-low-birth-weight infants in the German Neonatal Network.

    Directory of Open Access Journals (Sweden)

    Kathrin Hanke

    Full Text Available It was the aim of our study to evaluate the independent effect of preterm prelabor rupture of membranes (PPROM as a cause of preterm delivery on mortality during primary hospital stay and significant morbidities in very-low-birth-weight (VLBW infants < 32 weeks of gestation.Observational, epidemiological study design.Population-based cohort, German Neonatal Network (GNN.6102 VLBW infants were enrolled in GNN from 2009-2012, n=4120 fulfilled criteria for primary analysis (< 32 gestational weeks, no pre-eclampsia, HELLP (highly elevated liver enzymes and low platelets syndrome or placental abruption as cause of preterm birth.Multivariable logistic regression analyses included PPROM as potential risk factors for adverse outcomes and well established items such as gestational age in weeks, birth weight, antenatal steroids, center, inborn delivery, multiple birth, gender and being small-for-gestational-age.PPROM as cause of preterm delivery had no independent effect on the risk of early-onset sepsis, clinical sepsis and blood-culture proven sepsis, while gestational age proved to be the most important contributor to sepsis risk. The diagnosis of PPROM was associated with an increased risk for bronchopulmonary dysplasia (BPD; OR: 1.25, 95% CI: 1.02-1.55, p=0.03 but not with other major outcomes.The diagnosis of PPROM per se is not associated with adverse outcome in VLBW infants < 32 weeks apart from a moderately increased risk for BPD. Randomized controlled trials with primary neonatal outcomes are needed to determine which subgroup of VLBW infants benefit from expectant or intentional management of PPROM.

  16. Adverse outcome pathways (AOPs): A framework to support predictive toxicology

    Science.gov (United States)

    High throughput and in silico methods are providing the regulatory toxicology community with capacity to rapidly and cost effectively generate data concerning a chemical’s ability to initiate one or more biological perturbations that may culminate in an adverse ecological o...

  17. Population-based study of smoking behaviour throughout pregnancy and adverse perinatal outcomes.

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2013-09-01

    There has been limited research addressing whether behavioural change in relation to smoking is maintained throughout pregnancy and the effect on perinatal outcomes. A cohort study addressed lifestyle behaviours of 907 women who booked for antenatal care and delivered in a large urban teaching hospital in 2010-2011. Adverse perinatal outcomes were compared for "non-smokers", "ex-smokers" and "current smokers". Of the 907 women, 270 (30%) reported smoking in the six months prior to pregnancy, and of those 160 (59%) had stopped smoking and 110 (41%) continued to smoke at the time of the first antenatal visit. There was virtually no change in smoking behaviour between the first antenatal visit and the third trimester of pregnancy. Factors associated with continuing to smoke included unplanned pregnancy (OR 1.9; 95% CI 1.3, 2.9), alcohol use (OR 3.4; 95% CI 2.1, 6.0) and previous illicit drug use (OR 3.6; 95% CI 2.1, 6.0). Ex-smokers had similar perinatal outcomes to non-smokers. Current smoking was associated with an average reduction in birth weight of 191 g (95% CI -294, -88) and an increased incidence of intrauterine growth restriction (24% versus 13%, adjusted OR 1.39 (95% CI 1.06, 1.84). Public Health campaigns emphasise the health benefits of quitting smoking in pregnancy. The greatest success appears to be pre-pregnancy and during the first trimester where women are largely self-motivated to quit.

  18. Background rates of adverse pregnancy outcomes for assessing the safety of maternal vaccine trials in sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Lauren A V Orenstein

    Full Text Available BACKGROUND: Maternal immunization has gained traction as a strategy to diminish maternal and young infant mortality attributable to infectious diseases. Background rates of adverse pregnancy outcomes are crucial to interpret results of clinical trials in Sub-Saharan Africa. METHODS: We developed a mathematical model that calculates a clinical trial's expected number of neonatal and maternal deaths at an interim safety assessment based on the person-time observed during different risk windows. This model was compared to crude multiplication of the maternal mortality ratio and neonatal mortality rate by the number of live births. Systematic reviews of severe acute maternal morbidity (SAMM, low birth weight (LBW, prematurity, and major congenital malformations (MCM in Sub-Saharan African countries were also performed. FINDINGS: Accounting for the person-time observed during different risk periods yields lower, more conservative estimates of expected maternal and neonatal deaths, particularly at an interim safety evaluation soon after a large number of deliveries. Median incidence of SAMM in 16 reports was 40.7 (IQR: 10.6-73.3 per 1,000 total births, and the most common causes were hemorrhage (34%, dystocia (22%, and severe hypertensive disorders of pregnancy (22%. Proportions of liveborn infants who were LBW (median 13.3%, IQR: 9.9-16.4 or premature (median 15.4%, IQR: 10.6-19.1 were similar across geographic region, study design, and institutional setting. The median incidence of MCM per 1,000 live births was 14.4 (IQR: 5.5-17.6, with the musculoskeletal system comprising 30%. INTERPRETATION: Some clinical trials assessing whether maternal immunization can improve pregnancy and young infant outcomes in the developing world have made ethics-based decisions not to use a pure placebo control. Consequently, reliable background rates of adverse pregnancy outcomes are necessary to distinguish between vaccine benefits and safety concerns. Local studies

  19. Association of gestational weight gain and pre-pregnancy body mass index with adverse pregnancy outcome

    International Nuclear Information System (INIS)

    Objective: To determine the association between gestation weight gain (GWG) and adverse pregnancy outcome in a Pakistani population. Study Design: Analytical study. Place and Duration of Study: The Aga Khan University, Karachi, from February 2003 to 2007. Methodology: This study used secondary data of 4,735 women from a large cohort study on fetal growth. Pre-pregnancy BMI was categorized according to the recommendations from the institute of medicine (IOM, 2009) and gestation weight gain (GWG) was noted. Chi-square test was used to find the association of GWG and pre-pregnancy BMI with low birth, large for gestational age (LGA), and caesarean section. Logistic regression analysis was weight (LBW), preterm delivery performed to control for confounders like age, parity, working status and ethnicity. Results: The prevalence of LBW decreased with increasing BMI. GWG of the population was noted as 8.5 kg. LBW was omen below the age of 19 were twice more likely to have LBW than observed to have an inverse relationship with GWG. W above 35 years of age. Weight gain above the recommended range were twice more likely to have large for dates. Overweight women were 1.5 times more likely to deliver preterm whereas obese women were 1.4 times more likely to undergo caesarean section than women with normal BMI. Conclusion: The optimal weight gain was estimated to be 8.5 kg to prevent low birth weight in our population. Obese women are more likely to have LGA, caesarean sections and pre-term deliveries. (author)

  20. Reproductive outcomes in adolescents who had a previous birth or an induced abortion compared to adolescents' first pregnancies

    Directory of Open Access Journals (Sweden)

    Wenzlaff Paul

    2008-01-01

    Full Text Available Abstract Background Recently, attention has been focused on subsequent pregnancies among teenage mothers. Previous studies that compared the reproductive outcomes of teenage nulliparae and multiparae often did not consider the adolescents' reproductive histories. Thus, the authors compared the risks for adverse reproductive outcomes of adolescent nulliparae to teenagers who either have had an induced abortion or a previous birth. Methods In this retrospective cohort study we used perinatal data prospectively collected by obstetricians and midwives from 1990–1999 (participation rate 87–98% of all hospitals in Lower Saxony, Germany. From the 9742 eligible births among adolescents, women with multiple births, >1 previous pregnancies, or a previous spontaneous miscarriage were deleted and 8857 women Results In bivariate logistic regression analyses, compared to nulliparous teenagers, adolescents with a previous birth had higher risks for perinatal [OR = 2.08, CI = 1.11,3.89] and neonatal [OR = 4.31, CI = 1.77,10.52] mortality and adolescents with a previous abortion had higher risks for stillbirths [OR = 3.31, CI = 1.01,10.88] and preterm births [OR = 2.21, CI = 1.07,4.58]. After adjusting for maternal nationality, partner status, smoking, prenatal care and pre-pregnancy BMI, adolescents with a previous birth were at higher risk for perinatal [OR = 2.35, CI = 1.14,4.86] and neonatal mortality [OR = 4.70, CI = 1.60,13.81] and adolescents with a previous abortion had a higher risk for very low birthweight infants [OR = 2.74, CI = 1.06,7.09] than nulliparous teenagers. Conclusion The results suggest that teenagers who give birth twice as adolescents have worse outcomes in their second pregnancy compared to those teenagers who are giving birth for the first time. The prevention of the second pregnancy during adolescence is an important public health objective and should be addressed by health care providers who attend the first birth or the abortion

  1. Medical abortion and the risk of subsequent adverse pregnancy outcomes

    DEFF Research Database (Denmark)

    Virk, Jasveer; Zhang, Jun; Olsen, Jørn

    2007-01-01

    BACKGROUND: The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available regarding the effects of this procedure on subsequent pregnancies. METHODS: We...... identified all women living in Denmark who had undergone an abortion for nonmedical reasons between 1999 and 2004 and obtained information regarding subsequent pregnancies from national registries. Risks of ectopic pregnancy, spontaneous abortion, preterm birth (at ... weight (abortion were compared with risks in women who had had a first-trimester surgical abortion. RESULTS: Among 11,814 pregnancies in women who had had a previous first-trimester medical abortion (2710 women...

  2. STUDY OF RISK FACTORS CONTRIBUTING TO ADVERSE NEONATAL OUTCOME IN HYPERTENSIVE MOTHERS COMPARED TO NON HYPERTENSIVE MOTHERS

    Directory of Open Access Journals (Sweden)

    Swapna K

    2015-06-01

    Full Text Available AIM: To study the various risk factors in hypertensive mothers that contribute to adverse neonatal outcome in the form of low birth weight when compared to non - hypertensive mothers. SETTING: The study was conducted in the Inborn NICU and New born Follow up clinic of Department of Paediatrics in a rural Government medical college Hospital. STUDY DESIGN: Prospective cohort study. MATERIALS AND METHODS: INCLUSION CRITERIA: CASES: Consecutive sam ple of mothers with pregnancy induced hypertension during the study period who have given consent for the study were interviewed and their live born babies were included as cases. CONTROLS: Consecutive sample of live born babies born to non - hypertensive mo thers in the same study period were included as controls . Exclusion Criteria: Babies with major congenital anomalies chromosomal anomalies, intrauterine death were excluded . METHODOLOGY: Details of maternal risk factors were collected. Anthropometric parame ters, systemic examination, development and maturity of the babies were assessed. STATISTICAL TESTING: Significance testing was done using chi square test, odds ratio, analysis of risk ratios and cor r elation testing . P values greater than .05 were considered non - significant. Spss 16 Software package was used for statistical analysis. RESULTS: The incidence of low birth weight in this study was 45.6% which is considerably higher than in controls (16.6% and in the general population (19.1%. 33.8% of babies were preterm among the cases compared to 6.1% among controls. Among mothers with hypertension detected before 30 weeks, 90.3% had low birth weight babies. Among mothers with severe hypertension, 86.4% had low birth weight babies compared to 29.8% amo ng those with mild hypertension.92.3% pregnancies with Doppler abnormalities had LBW. 70.8% of LBW babies had antenatal intra uterine growth restriction.90.1% of hypertensive mothers with albuminuria had associated LBW. 100% babies had low birth

  3. Do cash transfers improve birth outcomes? Evidence from matched vital statistics, social security and program data

    OpenAIRE

    Amarante, Veronica; Manacorda, Marco; Miguel, Edward; Vigorito, Andrea

    2011-01-01

    There is limited empirical evidence on whether unrestricted cash social assistance to poor pregnant women improves children's birth outcomes. Using program administrative micro-data matched to longitudinal vital statistics on the universe of births in Uruguay, we estimate that participation in a generous cash transfer program led to a sizeable 15% reduction in the incidence of low birthweight. Improvements in mother nutrition and a fall in labor supply, out-of-wedlock births and mother's smok...

  4. Sacral Nerve Stimulation for Constipation: Suboptimal Outcome and Adverse Events

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Lundby, Lilli; Buntzen, Steen;

    2010-01-01

    Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events....

  5. Reported estimates of adverse pregnancy outcomes among women with and without syphilis: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Jiabi Qin

    Full Text Available To estimate probability of adverse pregnancy outcomes (APOs among women with and without syphilis through a systematic review of published literatures.Chinese and English literatures were searched for studies assessing pregnancy outcomes in the presence of maternal syphilis through August 2013. The prevalence estimates were summarized and analyzed by meta-analysis. Fifty-four literatures involving 11398 syphilitic women and 43342 non-syphilitic women were included from 4187 records initially found. Among untreated mothers with syphilis, pooled estimates were 76.8% for all APOs, 36.0% for congenital syphilis, 23.2% for preterm, 23.4% for low birth weight, 26.4% for stillbirth or fetal loss, 14.9% for miscarriage and 16.2% for neonatal deaths. Among syphilitic mother receiving treatment only in the late trimester (>28 weeks, pooled estimates were 64.4% for APOs, 40.6% for congenital syphilis, 17.6% for preterm, 12.4% for low birth weight, and 21.3% for stillbirth or fetal loss. Among syphilitic mothers with high titers (≥1∶8, pooled estimates were 42.8% for all APOs, 25.8% for congenital syphilis, 15.1% for preterm, 9.4% for low birth weight, 14.6% for stillbirth or fetal loss and 16.0% for neonatal deaths. Among non-syphilitic mothers, the pooled estimates were 13.7% for all APOs, 7.2% for preterm birth, 4.5% for low birth weight, 3.7% for stillbirth or fetal loss, 2.3% for miscarriage and 2.0% for neonatal death. Begg's rank correlation test indicated little evidence of publication bias (P>0.10. Substantial heterogeneity was found across studies in the estimates of all adverse outcomes for both women with syphilis (I2 = 93.9%; P<0.0001 and women without syphilis (I2 = 94.8%; P<0.0001.Syphilis continues to be an important cause of substantial perinatal morbidity and mortality, which reminds that policy-makers charged with resource allocation that the elimination of mother-to-child transmission of syphilis is a public health priority.

  6. Adverse health outcomes in offspring of mothers with cosmetic breast implants : A review

    NARCIS (Netherlands)

    Kjoller, Kim; Friis, Soren; Lipworth, Loren; McLaughlin, Joseph K.; Olsen, Jorgen H.

    2007-01-01

    Background: To assess whether maternal cosmetic breast implants are associated with adverse health outcomes among offspring, the authors examined published findings of epidemiologic studies that addressed this hypothesis. Methods: Four epidemiologic studies, ail from Scandinavia, were identified. Wo

  7. Prenatal Phenol and Phthalate Exposures and Birth Outcomes

    OpenAIRE

    Wolff, Mary S.; Engel, Stephanie M.; Berkowitz, Gertrud S; Ye, Xiaoyun; Silva, Manori J.; Zhu, Chenbo; Wetmur, James; Calafat, Antonia M.

    2008-01-01

    Background Many phthalates and phenols are hormonally active and are suspected to alter the course of development. Objective We investigated prenatal exposures to phthalate and phenol metabolites and their associations with body size measures of the infants at birth. Methods We measured 5 phenol and 10 phthalate urinary metabolites in a multiethnic cohort of 404 women in New York City during their third trimester of pregnancy and recorded size of infants at birth. Results Median urinary conce...

  8. Femoral and Inguinal Hernia : How to Minimize Adverse Outcomes Following Repair

    OpenAIRE

    Dahlstrand, Ursula

    2011-01-01

    Groin hernia is common, and each year 200 repairs per 100 000 adult inhabitants are performed in Sweden. Groin hernias are either inguinal or femoral (2-4%). Elective repair is not associated with an excess mortality, but adverse outcomes include recurrence and long-term pain. Emergency procedures have a 4% mortality rate with an increased risk for bowel resection and postoperative complications. The aim of this thesis was to identify risk factors for adverse outcomes and to propose measures ...

  9. No association between anxiety and depression and adverse clinical outcome among patients with cardiovascular disease

    DEFF Research Database (Denmark)

    Kornerup, Henriette; Zwisler, Ann-Dorthe Olsen; Prescott, Eva

    2011-01-01

    Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far.......Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far....

  10. Research progress of environmental factors of adverse pregnancy outcomes%不良妊娠结局的环境因素研究进展

    Institute of Scientific and Technical Information of China (English)

    姜波玲; 卢媛

    2013-01-01

    妊娠不良结局的相关因素很多,这些危险因素影响着孕妇的健康,增加不良妊娠结局风险,包括早产、低出生体重、出生缺陷等。导致妊娠不良结局的原因目前主要分为母体、胎儿、环境三方面。研究环境因素与不良妊娠结局的关系,减少孕妇高危环境暴露,提前采取干预措施,可避免不良妊娠结局的发生。该文就不良妊娠结局的环境因素研究进展进行综述。%There are many related risk factors of adverse pregnancy outcomes , which affect the health of pregnant women and lead to the increase of adverse pregnancy outcomes , including preterm delivery, low birth weight, birth defects, etc.The causes of adverse pregnancy outcomes are mainly from the aspects of parent , fetus and environment .Studying on the relationship between environmental factors and adverse pregnancy outcomes of pregnant women , reducing environment exposure of pregnant women and taking preventive measures beforehand can avoid adverse pregnancy outcomes .This article gave an overview of research progress on environmental factors in adverse pregnancy outcome .

  11. Clinical factors adversely affecting early outcome after brain infarction

    Directory of Open Access Journals (Sweden)

    Charles André

    1994-06-01

    Full Text Available PURPOSE AND METHODS: One-hundred-and-nine consecutive patients admitted during the acute phase of a CT-confirmed brain infarction (BI were studied. Putative adverse influence of demographic and stroke risk factors, previous medical history, clinical presentation, initial and follow-up neurological examination, initial general evaluation, laboratory findings, chest X-ray and electrocardiographic findings, treatment, and topography and etiology of the ischemic insult was analysed. The end-point for assessment was early death (within 30 days. Statistical analysis was performed with univariate analysis and multiple regression. RESULTS: The main adverse factors related to an increased death risk during the first 30 days were, in decreasing order of importance: coma 48-72 hours after admission; stroke occuring in already hospitalized patients; Babinski sign on admission; minor degrees of impairment of consciousness 48-72 hours after admission; stroke related to large artery atherothrombosis and to embolism; a history of early impairment of consciousness; cardiac failure on admission. In 53 lucid patients on admission, only a history of congestive heart failure (CHF was associated with a reduced survival rate. In 56 patients with impaired consciousness, the presence of a Babinski sign increased death risk, but the main factor predicting a high case-fatality rate was the persistence of consciousness disturbances after48-72 hours. CONCLUSIONS: The presence of impairment of consciousness, especially coma, 2-3 days after disease onset, and a history of CHF greatly increase the early case fatality rate in patients with acute BI presenting with or without consciousness disturbances at admission, respectively. The use of a prognostic algorythm considering these few variables seems to predict the approximate 30-day fatality rates.

  12. Geographic Distribution of Healthy Resources and Adverse Pregnancy Outcomes.

    Science.gov (United States)

    Young, Christopher; Laurent, Olivier; Chung, Judith H; Wu, Jun

    2016-08-01

    Objective To determine the risk of gestational diabetes (GDM) and preeclampsia associated with various community resources. Methods An ecological study was performed in Los Angeles and Orange counties in California. Fast food restaurants, supermarkets, grocery stores, gyms, health clubs and green space were identified using Google © Maps Extractor and through the Southern California Association of Government. California Birth Certificate data was used to identify cases of GDM and preeclampsia. Unadjusted and adjusted risk ratios were calculated using negative binomial regression. Results There were 9692 cases of GDM and 6288 cases of preeclampsia corresponding to incidences of 2.5 and 1.4 % respectively. The adjusted risk of GDM was reduced in zip codes with greater concentration of grocery stores [relative risk (RR) 0.95, 95 % confidence interval (CI) 0.92-0.99] and supermarkets (RR 0.94, 95 % CI 0.90-0.98). There were no significant relationships between preeclampsia and the concentration of fast food restaurants, grocery store, supermarkets or the amount of green space. Conclusion The distribution of community resources has a significant association with the risk of developing GDM but not preeclampsia. PMID:26994606

  13. Geographic Distribution of Healthy Resources and Adverse Pregnancy Outcomes.

    Science.gov (United States)

    Young, Christopher; Laurent, Olivier; Chung, Judith H; Wu, Jun

    2016-08-01

    Objective To determine the risk of gestational diabetes (GDM) and preeclampsia associated with various community resources. Methods An ecological study was performed in Los Angeles and Orange counties in California. Fast food restaurants, supermarkets, grocery stores, gyms, health clubs and green space were identified using Google © Maps Extractor and through the Southern California Association of Government. California Birth Certificate data was used to identify cases of GDM and preeclampsia. Unadjusted and adjusted risk ratios were calculated using negative binomial regression. Results There were 9692 cases of GDM and 6288 cases of preeclampsia corresponding to incidences of 2.5 and 1.4 % respectively. The adjusted risk of GDM was reduced in zip codes with greater concentration of grocery stores [relative risk (RR) 0.95, 95 % confidence interval (CI) 0.92-0.99] and supermarkets (RR 0.94, 95 % CI 0.90-0.98). There were no significant relationships between preeclampsia and the concentration of fast food restaurants, grocery store, supermarkets or the amount of green space. Conclusion The distribution of community resources has a significant association with the risk of developing GDM but not preeclampsia.

  14. ADVERSE MATERNAL AND PERINATAL OUTCOMES IN GESTATIONAL DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    Ambarisha Bhandiwad, Divyasree B, Surakshith L Gowda

    2015-10-01

    Full Text Available Introduction: Women with Gestational Diabetes Mellitus (GDM are at increased risk for many other health concerns with short and long-term implications for both mother and child. They are at higher risk for glucose-mediated macrosomia, hypertension, birth trauma, respiratory distress, hypoglycemia, hyperbilirubinemia with increased neonatal intensive care unit (NICU admissions. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovascular disease in the mothers. Objectives: To study the incidence of maternal and fetal co-morbidities associated with GDM. Materials and Methods: This is a retrospective observational study where cases with GDM were analyzed for maternal and fetal complications. Results: 189 cases were detected to be Gestational Diabetes Mellitus, out of which 63.49% cases developed co-morbidities with GDM. 11.11% cases developed preeclampsia, 9.52% had polyhydramnios, 5.8% patients went into preterm labour, 3 cases had Antepartum Haemorrhage and one case had Postpartum Haemorrhage. 19.57% cases developed macrosomia, hypoglycemia was seen in 7.40% babies and hyperbilirubinemia in 3.70% babies. 6 Intra Uterine Deaths and 2 still borns were documented. Conclusion: GDM is a condition which is worth monitoring and treating, since it has been demonstrated that good metabolic control maintained throughout gestation can reduce maternal and fetal complications.

  15. "PREVALENCE, MATERNAL COMPLICATIONS AND BIRTH OUTCOME OF PHYSICAL, SEXUAL AND EMOTIONAL DOMESTIC VIOLENCE DURING PREGNANCY"

    OpenAIRE

    M Faramarzi; S. Esmaelzadeh; S. Mosavi

    2005-01-01

    The prevalence of physical violence during pregnancy varies widely in different societies. To assess the incidence of self-reported physical, emotional and sexual violence in pregnancy and describe the association with maternal complication and birth outcomes, 3275 women who gave birth to live-born infants from October 2002 to November 2003 were assessed for self-reported violence in postpartum units of Obstetrics Department of Babol university of Medical Sciences. Outcome data included mater...

  16. Women referred for occupational risk assessment in pregnancy have no increased risk of adverse obstetric outcomes

    DEFF Research Database (Denmark)

    Bidstrup, Signe Brøker; Kaerlev, Linda; Thulstrup, Ane Marie;

    2015-01-01

    pregnant women referred to two Danish clinics of occupational medicine (Copenhagen and Aarhus) from 1984 to 2010 were compared with the referred women's 1,077 non-referred pregnancy outcomes and with the pregnancy outcomes of 345,467 gainfully employed women from the same geographical areas and time period....... Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Calculations were adjusted for the mother's age at delivery, parity, ethnicity, socioeconomic status, smoking, and in supplementary analyses for year of birth. RESULTS: Referred women gave birth to children...

  17. Adult outcomes of teen mothers across birth cohorts

    Directory of Open Access Journals (Sweden)

    Anne Driscoll

    2014-04-01

    Full Text Available Background: Teen and young adult mothers have lower socioeconomic status than older mothers. Objective: This study analyzes the socioeconomic status (SES of teen, young adult, and older adult mothers across four five-year birth cohorts from 1956 to 1975 who were teens from 1971 to 1994. Methods: Data were pooled from the 1995, 2002, and 2006-2010 National Survey of Family Growth (NSFG. Mothers were categorized by age at first birth and by their birth cohorts. The SES (education, single motherhood, poverty, employment of teen, young adult, and older mothers was compared across cohorts and within cohorts. Results: Among teen mothers, the odds of fulltime employment improved across birth cohorts and the odds of educational attainment beyond high school did not vary. Their odds of single motherhood and living in poverty increased across cohorts. The odds of higher education and single motherhood increased across birth cohorts for young adult mothers as did the odds of living in poverty, even if working fulltime. Among older adult mothers, educational attainment and the odds of single motherhood rose for recent cohorts. Conclusions: Comparisons between teen mothers and both young adult and all adult mothers within cohorts suggest that gaps in single motherhood and poverty between teen and adult mothers have widened over time, to the detriment of teen mothers. Teen mothers have become more likely to be single and poor than in the past and compared to older mothers.

  18. Do Cash Transfers Improve Birth Outcomes? Evidence from Matched Vital Statistics, Program and Social Security Data

    OpenAIRE

    Amarante, Verónica; Manacorda, Marco; Miguel, Edward; Vigorito, Andrea

    2012-01-01

    There is limited empirical evidence on whether cash social assistance to poor pregnant women improves children’s birth outcomes. Using program administrative micro-data matched to longitudinal vital statistics on the universe of births in Uruguay, we estimate that participation in a generous cash transfer program led to a sizeable 15 to 17% reduction in the incidence of low birth weight. Improvements in mother nutrition and a fall in labor supply, out-of-wedlock births and mother’s smoking al...

  19. Individual and health facility factors and the risk for obstructed labour and its adverse outcomes in south-western Uganda

    Directory of Open Access Journals (Sweden)

    Turyakira Eleanor

    2011-10-01

    Full Text Available Abstract Background Obstructed labour is still a major cause of maternal morbidity and mortality and of adverse outcome for newborns in low-income countries. The aim of this study was to investigate the role of individual and health facility factors and the risk for obstructed labour and its adverse outcomes in south-western Uganda. Methods A review was performed on 12,463 obstetric records for the year 2006 from six hospitals located in south-western Uganda and 11,180 women records were analysed. Multivariate logistic regression analyses were applied to control for probable confounders. Results Prevalence of obstructed labour for the six hospitals was 10.5% and the main causes were cephalopelvic disproportion (63.3%, malpresentation or malposition (36.4% and hydrocephalus (0.3%. The risk of obstructed labour was statistically significantly associated with being resident of a particular district [Isingiro] (AOR 1.39, 95% CI: 1.04-1.86, with nulliparous status (AOR 1.47, 95% CI: 1.22-1.78, having delivered once before (AOR 1.57, 95% CI: 1.30-1.91 and age group 15-19 years (AOR 1.21, 95% CI: 1.02-1.45. The risk for perinatal death as an adverse outcome was statistically significantly associated with districts other than five comprising the study area (AOR 2.85, 95% CI: 1.60-5.08 and grand multiparous status (AOR 1.89, 95% CI: 1.11-3.22. Women who lacked paid employment were at increased risk of obstructed labour. Perinatal mortality rate was 142/1000 total births in women with obstructed labour compared to 65/1000 total births in women without the condition. The odds of having maternal complications in women with obstructed labour were 8 times those without the condition. The case fatality rate for obstructed labour was 1.2%. Conclusions Individual socio-demographic and health system factors are strongly associated with obstructed labour and its adverse outcome in south-western Uganda. Our study provides baseline information which may be used by

  20. Cortisol Reactivity to Social Stress as a Mediator of Early Adversity on Risk and Adaptive Outcomes

    Science.gov (United States)

    Conradt, Elisabeth; Abar, Beau; Lester, Barry M.; LaGasse, Linda L.; Shankaran, Seetha; Bada, Henrietta; Bauer, Charles R.; Whitaker, Toni M.; Hammond, Jane A.

    2014-01-01

    Children chronically exposed to stress early in life are at increased risk for maladaptive outcomes, though the physiological mechanisms driving these effects are unknown. Cortisol reactivity was tested as a mediator of the relation between prenatal substance exposure and/or early adversity on adaptive and maladaptive outcomes. Data were drawn…

  1. Theoretical Framework to Extend Adverse Outcome Pathways to Include Pharmacokinetic Considerations

    Science.gov (United States)

    Adverse Outcome Pathways (AOPs) have generated intense interest for their utility in linking known population outcomes to a molecular initiating event (MIE) that can be quantified using in vitro methods. While there are tens of thousands of chemicals in commercial use, biology h...

  2. Effect of balanced protein energy supplementation during pregnancy on birth outcomes

    Directory of Open Access Journals (Sweden)

    Bhutta Zulfiqar A

    2011-04-01

    Full Text Available Abstract Background The nutritional status of the mother prior to and during pregnancy plays a vital role in fetal growth and development, and maternal undernourishment may lead to adverse perinatal outcomes including intrauterine growth restriction (IUGR. Several macronutrient interventions had been proposed for adequate protein and energy supplementation during pregnancy. The objective of this paper was to review the effect of balanced protein energy supplementation during pregnancy on birth outcomes. This paper is a part of a series of reviews undertaken for getting estimates of effectiveness of an intervention for input to Lives Saved Tool (LiST model. Methods A literature search was conducted on PubMed, Cochrane Library and WHO regional data bases to identify randomized trials (RCTs and quasi RCTs that evaluated the impact of balanced protein energy supplementation in pregnancy. Balanced protein energy supplementation was defined as nutritional supplementation during pregnancy in which proteins provided less than 25% of the total energy content. Those studies were excluded in which the main intervention was dietary advice to pregnant women for increase in protein energy intake, high protein supplementation (i.e. supplementation in which protein provides at least 25% of total energy content, isocaloric protein supplementation (where protein replaces an equal quantity of non-protein energy content, or low energy diet to pregnant women who are either overweight or who exhibit high weight gain earlier in gestation. The primary outcomes were incidence of small for gestational age (SGA birth, mean birth weight and neonatal mortality. Quality of evidence was evaluated according to the Child Health Epidemiology Reference group (CHERG adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE criteria. Results The final number of studies included in our review was eleven comprising of both RCTs and quasi-RCTs. Our meta

  3. A national study of the association between traffic-related air pollution and adverse pregnancy outcomes in Canada, 1999-2008.

    Science.gov (United States)

    Stieb, David M; Chen, Li; Hystad, Perry; Beckerman, Bernardo S; Jerrett, Michael; Tjepkema, Michael; Crouse, Daniel L; Omariba, D Walter; Peters, Paul A; van Donkelaar, Aaron; Martin, Randall V; Burnett, Richard T; Liu, Shiliang; Smith-Doiron, Marc; Dugandzic, Rose M

    2016-07-01

    Numerous studies have examined the association of air pollution with preterm birth and birth weight outcomes. Traffic-related air pollution has also increasingly been identified as an important contributor to adverse health effects of air pollution. We employed a national nitrogen dioxide (NO2) exposure model to examine the association between NO2 and pregnancy outcomes in Canada between 1999 and 2008. National models for NO2 (and particulate matter of median aerodynamic diameter land use variables and, for NO2, deterministic gradients relative to road traffic sources. Generalized estimating equations were used to examine associations with preterm birth, term low birth weight (LBW), small for gestational age (SGA) and term birth weight, adjusting for covariates including infant sex, gestational age, maternal age and marital status, parity, urban/rural place of residence, maternal place of birth, season, year of birth and neighbourhood socioeconomic status and per cent visible minority. Associations were reduced considerably after adjustment for individual covariates and neighbourhood per cent visible minority, but remained significant for SGA (odds ratio 1.04, 95%CI 1.02-1.06 per 20ppb NO2) and term birth weight (16.2g reduction, 95% CI 13.6-18.8g per 20ppb NO2). Associations with NO2 were of greater magnitude in a sensitivity analysis using monthly monitoring data, and among births to mothers born in Canada, and in neighbourhoods with higher incomes and a lower proportion of visible minorities. In two pollutant models, associations with NO2 were less sensitive to adjustment for PM2.5 than vice versa, and there was consistent evidence of a dose-response relationship for NO2 but not PM2.5. In this study of approximately 2.5 million Canadian births between 1999 and 2008, we found significant associations of NO2 with SGA and term birth weight which remained significant after adjustment for PM2.5, suggesting that traffic may be a particularly important source with

  4. Vaginal Fluid Inflammatory Biomarkers and the Risk of Adverse Neonatal Outcomes in Women with PPROM.

    Science.gov (United States)

    Dorfeuille, Nydia; Morin, Valérie; Tétu, Amélie; Demers, Suzanne; Laforest, Geneviève; Gouin, Katy; Piedboeuf, Bruno; Bujold, Emmanuel

    2016-08-01

    Objective The purpose of this study was to evaluate the predictive value of vaginal fluid biomarkers for chorioamnionitis and adverse perinatal outcomes in women with preterm premature rupture of membranes (PPROM). Methods We recruited women with PPROM, without clinical chorioamnionitis, between 22 and 36 weeks' gestation. Vaginal fluid was collected on admission for the measurement of metalloproteinase-8 (MMP-8), interleukin-6 (IL-6), lactate, and glucose concentration. Placental pathology and neonatal charts were reviewed. Primary outcomes were histological chorioamnionitis and adverse neonatal neurological outcomes (intraventricular hemorrhage grade 2 or 3, periventricular leukomalacia, or hypoxic/ischemic encephalopathy). Linear regression analyses were used to adjust for gestational age at PPROM. Results Twenty-seven women were recruited at a mean gestational age of 31.6 ± 3.1 weeks, including 25 (93%) with successful collection of vaginal fluid sample. Histological chorioamnionitis and adverse neonatal neurological outcomes were observed in nine (33%) and four (15%) cases, respectively. In univariate analysis, MMP-8, IL-6, glucose, and lactate concentrations in vaginal fluid were associated with the risk of chorioamnionitis but not anymore after adjustment for gestational age at PPROM. MMP-8 concentration was the only biomarker associated with adverse neurological outcome, and it remained significant after adjustment for gestational age at PPROM (p = 0.02). Conclusion Vaginal fluid inflammatory biomarkers at admission for PPROM could predict adverse perinatal outcomes. PMID:27120475

  5. Adverse obstetric and perinatal outcomes following treatment of adolescent and young adult cancer: a population-based cohort study.

    Directory of Open Access Journals (Sweden)

    Fatima A Haggar

    Full Text Available OBJECTIVE: To investigate obstetric and perinatal outcomes among female survivors of adolescent and young adult (AYA cancers and their offspring. METHODS: Using multivariate analysis of statewide linked data, outcomes of all first completed pregnancies (n = 1894 in female survivors of AYA cancer diagnosed in Western Australia during the period 1982-2007 were compared with those among females with no cancer history. Comparison pregnancies were matched by maternal age-group, parity and year of delivery. RESULTS: Compared with the non-cancer group, female survivors of AYA cancer had an increased risk of threatened abortion (adjusted relative risk 2.09, 95% confidence interval 1.51-2.74, gestational diabetes (2.65, 2.08-3.57, pre-eclampsia (1.32, 1.04-1.87, post-partum hemorrhage (2.83, 1.92-4.67, cesarean delivery (2.62, 2.22-3.04, and maternal postpartum hospitalization>5 days (3.01, 1.72-5.58, but no excess risk of threatened preterm delivery, antepartum hemorrhage, premature rupture of membranes, failure of labor to progress or retained placenta. Their offspring had an increased risk of premature birth (<37 weeks: 1.68, 1.21-2.08, low birth weight (<2500 g: 1.51, 1.23-2.12, fetal growth restriction (3.27, 2.45-4.56, and neonatal distress indicated by low Apgar score (<7 at 1 minute (2.83, 2.28-3.56, need for resuscitation (1.66, 1.27-2.19 or special care nursery admission (1.44, 1.13-1.78. Congenital abnormalities and perinatal deaths (intrauterine or ≤7 days of birth were not increased among offspring of survivors. CONCLUSION: Female survivors of AYA cancer have moderate excess risks of adverse obstetric and perinatal outcomes arising from subsequent pregnancies that may require additional surveillance or intervention.

  6. The Effect of Local Smokefree Regulations on Birth Outcomes and Prenatal Smoking.

    Science.gov (United States)

    Bartholomew, Karla S; Abouk, Rahi

    2016-07-01

    Objectives We assessed the impact of varying levels of smokefree regulations on birth outcomes and prenatal smoking. Methods We exploited variations in timing and regulation restrictiveness of West Virginia's county smokefree regulations to assess their impact on birthweight, gestational age, low birthweight, very low birthweight, preterm birth, and prenatal smoking. We conducted regression analysis using state Vital Statistics individual-level data for singletons born to West Virginia residents between 1995-2010 (N = 293,715). Results Only more comprehensive smokefree regulations were associated with statistically significant favorable effects on birth outcomes in the full sample: Comprehensive (workplace/restaurant/bar ban) demonstrated increased birthweight (29 grams, p workplace/restaurant ban) demonstrated a small decrease in very low birthweight (-0.2 %, p workplace ban) was associated with a 23 g (p women with Comprehensive. Conclusions Regulation restrictiveness is a determining factor in the impact of smokefree regulations on birth outcomes, with comprehensive smokefree regulations showing promise in improving birth outcomes. Favorable effects on birth outcomes appear to stem from reduced secondhand smoke exposure rather than reduced prenatal smoking prevalence. This study is limited by an inability to measure secondhand smoke exposure and the paucity of data on policy implementation and enforcement. PMID:26987859

  7. Adverse outcomes of pregnancy in HIV-positive women in the era of HAART: a perspective from an outer London centre in the UK

    Directory of Open Access Journals (Sweden)

    P Thayaparan

    2012-11-01

    Full Text Available Background: Increasing number of women with HIV are choosing to become pregnant as there is dramatic reduction in the risk of vertical transmission. However, management of HIV in pregnancy still poses a variety of challenges and adverse pregnancy outcomes are still common. We aimed to explore the factors associated with adverse outcomes of pregnancy in our HIV cohort. Methods: It is a retrospective case note review of all the women attended our unit and had HIV care from 2008–2011. A total of 87 women were followed up. Three women had two pregnancies during the study period. Data collected from Genitourinary Medicine and maternity records were analysed using SPSS program. Results: Mean age was 34 yrs ranging from 20–43 yrs. Majority (91% were of African origin; 67% had HIV subtype C; 26% resistant to one or more class of HIV drugs; 55% had a nadir CD4 fewer than 350; 44% diagnosed at an antenatal setting and 62% were planned pregnancies. Prior to the current pregnancy, these women had 121 children: 5% of the children have HIV and 33% not tested for HIV. Of the partners, 38% have HIV and 73% were aware of their partner's HIV status. None of the children born during the study period were infected with HIV; mean birth weight was 2789 g; there were 3 sets of twins; one still birth and one child died soon after birth. Around 46% were on anti-retroviral therapy (ART during conception, 6% had miscarriages and 16% had emergency caesarean sections. At delivery, viral load was detectable in 23%, mainly due to poor adherence (11% and late presentation (9%. 38% of the women experienced an obstetric complication, premature labour 9%; premature rupture of membranes and gestational diabetes both accounted to 4% whilst 3% had post-partum haemorrhage. On ART during conception and late HIV diagnosis that is nadir CD4, less than 350 cells were significantly associated (P<0.05 with having a foetal complication such as prematurity 8%, low birth weight 7% or

  8. Maternal Characteristics and Temporal Trends in Birth Outcomes: Comparison between Spanish and Migrant Mothers

    Directory of Open Access Journals (Sweden)

    Carlos Varea

    2012-01-01

    Full Text Available Low birth weight and preterm babies have been increasing in Spain since 1980, coinciding with important changes in the social and demographic structure of childbearing populations—including the contribution of a 25% of foreign mothers—and with increasing medical intervention in births. This study, based on 5,990,613 births, compares the temporary trends in reproductive patterns and birth outcomes in Spanish and foreign mothers during the period 1996–2009 and evaluates for the years 2007 to 2009 the relative contribution of mother's origin and Caesarean section to birth weight variability. Foreign mothers maintain their own reproductive pattern, whereas negative birth outcomes increase in all groups. Results from logistic regression analysis show that besides late maternity and primiparity also Caesarean section increases the risk for low birth weight. The reduction in Caesarean section rates between 2007 and 2009 might explain the reduction of low birth weight detected. A change of tendency simultaneously appears in most maternal and newborn characteristics, and in the mode of delivery in all ethnic groups since 2008. Coincidence in the timing of the change of trends points to a common factor. We suggest that the current world financial crisis could be this common cause, a hypothesis to be contrasted in future research.

  9. Developmental Outcome of Low-Birth-Weight Premature Infants

    OpenAIRE

    F Solimani

    2007-01-01

    Fetal and extrauterine life form a continuum during which human growth and development are affected by genetic, environmental, and social factors. Perinatal mortality is influenced by prenatal, maternal, and fetal conditions and by circumstances surrounding delivery. The majority of infants deaths and developmental disorders are due to disorders relating to prematurity and unspecified low birth weight (LBW), as well as maternal complications of pregnancy and congenital malformations (chromoso...

  10. Experiences of violence before and during pregnancy and adverse pregnancy outcomes: An analysis of the Canadian Maternity Experiences Survey

    Directory of Open Access Journals (Sweden)

    Heaman Maureen I

    2011-06-01

    Full Text Available Abstract Background Abuse and violence against women constitute a global public health problem and are particularly important among women of reproductive age. The literature is not conclusive regarding the impact of violence against pregnant women on adverse pregnancy outcomes, such as preterm birth, small for gestational age and postpartum depression. Most studies have been conducted on relatively small samples of high-risk women. Our objective was to investigate what dimensions of violence against pregnant women were associated with preterm birth, small for gestational age and postpartum depression in a nationally representative sample of Canadian women. Methods We analysed data of the Maternity Experiences Survey, a nationally representative survey of Canadian women giving birth in 2006. The comprehensive questionnaire included a 19-item section to collect information on different dimensions of abuse and violence, such as type, frequency, timing and perpetrator of violence. The survey design is a stratified simple random sample from the 2006 Canadian Census sampling frame. Participants were 6,421 biological mothers (78% response rate 15 years and older who gave birth to a singleton live birth and lived with their infant at the time of the survey. Logistic regression was used to compute Odds Ratios. Survey weights were used to obtain point estimates and 95% confidence intervals were obtained with the jacknife method of variance estimation. Covariate control was informed by use of directed acyclic graphs. Results No statistically significant associations were found for preterm birth or small for gestational age, after adjustment. Most dimensions of violence were associated with postpartum depression, particularly the combination of threats and physical violence starting before and continuing during pregnancy (Adjusted Odds Ratio = 4.1, 95% confidence interval: 1.9, 8.9 and perpetrated by the partner (4.3: 2.1, 8.7. Conclusions Our findings

  11. Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Kurtz WS

    2016-05-01

    pregnancy may be a marker for familial or acquired thrombophilia, which confers increased thrombotic risk to the mother and pregnancy, associated with spontaneous abortion or eclampsia. OVO during pregnancy, particularly when coupled with antecedent adverse pregnancy outcomes, should prompt urgent thrombophilia evaluation and institution of thromboprophylaxis to prevent adverse maternal and fetal–placental thrombotic events. Keywords: thrombophilia, ocular thrombosis, retinal vascular occlusion, CRVO, BRAO, pregnancy, miscarriage, fetal loss, ocular vascular occlusion, pre-eclampsia, eclampsia

  12. Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States.

    Science.gov (United States)

    Fejzo, Marlena S; MacGibbon, Kimber W; Mullin, Patrick M

    2016-07-01

    This is an analysis of fetal outcome in pregnancies exposed to ondansetron to treat Hyperemesis Gravidarum (HG). In this retrospective cohort study, U.S. data on outcome were collected on 1070 pregnancies exposed to ondansetron and compared to outcomes in two control groups: 771 pregnancies in women with a history of HG with no ondansetron exposure and 1555 pregnancies with neither a history of HG nor ondansetron exposure. Ventricular septal defects were reported in 2/952 of infants in the HG/Ondansetron-exposure group and 4/1286 in the No HG/No Ondansetron-exposure group. Cleft palate was reported in 1/952 live births in the HG/Ondansetron and 2/1286 in the No HG/No Ondansetron-exposure groups. Women with a history of HG who took ondansetron reported less miscarriages and terminations, and higher live birth rates. The overall results do not support evidence of teratogenicity of ondansetron. PMID:27151373

  13. Predicting adverse obstetric outcome after early pregnancy events and complications: a review

    DEFF Research Database (Denmark)

    van Oppenraaij, R H F; Jauniaux, E; Christiansen, O B;

    2009-01-01

    BACKGROUND The aim was to evaluate the impact of early pregnancy events and complications as predictors of adverse obstetric outcome. METHODS We conducted a literature review on the impact of first trimester complications in previous and index pregnancies using Medline and Cochrane databases......) after two or more miscarriages, the risk of placenta praevia, premature preterm rupture of membranes, VPTD and low birthweight (LBW) after recurrent miscarriage and the risk of VPTD after two or more termination of pregnancy. Clinically relevant associations of adverse obstetric outcome in the ongoing...... hyperemesis gravidarum. CONCLUSIONS Data from our literature review indicate, by finding significant associations, that specific early pregnancy events and complications are predictors for subsequent adverse obstetric and perinatal outcome. Though, some of these associations are based on limited or small...

  14. Prognostic potential of amniotic fluid analysis at birth on canine neonatal outcomes.

    Science.gov (United States)

    Groppetti, D; Martino, P A; Ravasio, G; Bronzo, V; Pecile, A

    2015-12-01

    Glucose, lactate and cortisol concentrations in amniotic fluid were measured at birth in 95 pups and related to neonatal viability based on Apgar scoring and to neonatal mortality. Neither amniotic parameters nor neonatal mortality were associated with the Apgar score. Stillborn pups showed high lactate (P amniotic concentrations (P amniotic fluid differences were observed between normal and malformed pups. Amniotic glucose (P amniotic fluid collected at birth could be a valuable predictor of neonatal outcomes in dogs.

  15. The effect of maternal stress on birth outcomes: exploiting a natural experiment.

    Science.gov (United States)

    Torche, Florencia

    2011-11-01

    A growing body of research highlights that in utero conditions are consequential for individual outcomes throughout the life cycle, but research assessing causal processes is scarce. This article examines the effect of one such condition-prenatal maternal stress-on birth weight, an early outcome shown to affect cognitive, educational, and socioeconomic attainment later in life. Exploiting a major earthquake as a source of acute stress and using a difference-in-difference methodology, I find that maternal exposure to stress results in a significant decline in birth weight and an increase in the proportion of low birth weight. This effect is focused on the first trimester of gestation, and it is mediated by reduced gestational age rather than by factors affecting the intrauterine growth of term infants. The findings highlight the relevance of understanding the early emergence of unequal outcomes and of investing in maternal well-being since the onset of pregnancy.

  16. Maternal employment during pregnancy and birth outcomes: evidence from Danish siblings.

    Science.gov (United States)

    Wüst, Miriam

    2015-06-01

    I use Danish survey and administrative data to examine the impact of maternal employment during pregnancy on birth outcomes. As healthier mothers are more likely to work and health shocks to mothers may impact employment and birth outcomes, I combine two strategies: First, I control extensively for time-varying factors that may correlate with employment and birth outcomes, such as pre-pregnancy family income and maternal occupation, pregnancy-related health shocks, maternal sick listing, and health behaviors (smoking and alcohol consumption). Second, to account for remaining time-invariant heterogeneity between mothers, I compare outcomes of mothers' consecutive children. Mothers who work during the first pregnancy trimester have a lower risk of preterm birth. I find no effect on the probability of having a baby of small size for gestational age. To rule out that health selection of mothers between pregnancies drives the results, I focus on mothers whose change in employment status is likely not to be driven by underlying health (mothers who are students in one of their pregnancies and mothers with closely spaced births). Given generous welfare benefits and strict workplace regulations in Denmark, my findings support a residual explanation, namely, that exclusion from employment may stress mothers in countries with high-female employment rates. PMID:24777685

  17. Laboratory work and pregnancy outcomes: a study within the National BirthCohort in Denmark

    DEFF Research Database (Denmark)

    Zhu, Jin Liang; Knudsen, L; Andersen, AM;

    2006-01-01

    AIMS: To examine pregnancy outcomes in women doing laboratory work. METHODS: Using data from the Danish National Birth Cohort (1997-2003), the authors conducted a prospective cohort study of 1025 female laboratory technicians and 8037 female teachers (as reference). The laboratory technicians were...... regression, and odds ratios (ORs) of preterm birth and small for gestational age were calculated by using logistic regression. RESULTS: Overall, there were no significant differences in pregnancy outcomes between laboratory technicians and teachers. However, we found that laboratory technicians working...

  18. Laboratory work and pregnancy outcomes: a study within the National Birth Cohort in Denmark

    DEFF Research Database (Denmark)

    Zhu, J L; Knudsen, Lisbeth E.; Andersen, Anne-Marie Nybo;

    2006-01-01

    AIMS: To examine pregnancy outcomes in women doing laboratory work. METHODS: Using data from the Danish National Birth Cohort (1997-2003), the authors conducted a prospective cohort study of 1025 female laboratory technicians and 8037 female teachers (as reference). The laboratory technicians were...... regression, and odds ratios (ORs) of preterm birth and small for gestational age were calculated by using logistic regression. RESULTS: Overall, there were no significant differences in pregnancy outcomes between laboratory technicians and teachers. However, we found that laboratory technicians working...

  19. Women referred for occupational risk assessment in pregnancy have no increased risk of adverse obstetric outcomes

    DEFF Research Database (Denmark)

    Bidstrup, Signe Brøker; Kaerlev, Linda; Thulstrup, Ane Marie;

    2015-01-01

    INTRODUCTION: Our aim was to study the association between pregnant women's referral status for occupational risk assessment, and their risk of preterm delivery (... pregnant women referred to two Danish clinics of occupational medicine (Copenhagen and Aarhus) from 1984 to 2010 were compared with the referred women's 1,077 non-referred pregnancy outcomes and with the pregnancy outcomes of 345,467 gainfully employed women from the same geographical areas and time period....... Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Calculations were adjusted for the mother's age at delivery, parity, ethnicity, socioeconomic status, smoking, and in supplementary analyses for year of birth. RESULTS: Referred women gave birth to children...

  20. Adverse Outcomes to Early Middle Age Linked With Childhood Residential Mobility

    DEFF Research Database (Denmark)

    Webb, Roger T; Pedersen, Carsten B; Mok, Pearl L H

    2016-01-01

    vigilance is indicated for relocated adolescents and their families, with a view to preventing longer-term adverse outcomes in this population among all socioeconomic groups. Risk management will require close cooperation among multiple public agencies, particularly child, adolescent, and adult mental...

  1. To study second trimester placental location as a predictor of adverse pregnancy outcome

    Directory of Open Access Journals (Sweden)

    Neetu Singh

    2016-05-01

    Conclusions: Placental localization by ultrasound in pregnant women during 18-24 week of gestation can be used as easy, non-invasive, cost-effective tool as a predictor of adverse pregnancy outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1414-1417

  2. Studying Biology to Understand Risk: Dosimetry Models and Quantitative Adverse Outcome Pathways

    Science.gov (United States)

    Confidence in the quantitative prediction of risk is increased when the prediction is based to as great an extent as possible on the relevant biological factors that constitute the pathway from exposure to adverse outcome. With the first examples now over 40 years old, physiologi...

  3. Risk factors for adverse outcome in preterm infants with periventricular hemorrhagic infarction

    NARCIS (Netherlands)

    Roze, Elise; Kerstjens, Jorien M.; Maathuis, Carel G. B.; ter Horst, Hendrik J.; Bos, Arend F.

    2008-01-01

    OBJECTIVE. Our objective was to identify risk factors that were associated with mortality and adverse neurologic outcome at 18 months of age in preterm infants with periventricular hemorrhagic infarction. METHODS. This was a retrospective cohort study of all preterm infants who were <37 weeks' gesta

  4. Teen Pregnancy : Are Pregnancies following an Elective Termination Associated with Increased Risk for Adverse Perinatal Outcomes?

    NARCIS (Netherlands)

    van Veen, Teelkien R.; Haeri, Sina; Baker, Arthur M.

    2015-01-01

    Study Objective: The authors sought to determine whether pregnancies in adolescents following an abortion of pregnancy is associated with an elevated risk for adverse perinatal outcomes. Methods: In a cohort study of all adolescent (younger than 18 years) deliveries over a 4-year period at 1 institu

  5. Birth outcomes in South African women receiving highly active antiretroviral therapy: a retrospective observational study

    Directory of Open Access Journals (Sweden)

    van der Merwe Karin

    2011-08-01

    Full Text Available Abstract Background Use of highly active antiretroviral therapy (HAART, a triple-drug combination, in HIV-infected pregnant women markedly reduces mother to child transmission of HIV and decreases maternal morbidity. However, there remains uncertainty about the effects of in utero exposure to HAART on foetal development. Methods Our objectives were to investigate whether in utero exposure to HAART is associated with low birth weight and/or preterm birth in a population of South African women with advanced HIV disease. A retrospective observational study was performed on women with CD4 counts ≤250 cells/mm3 attending antenatal antiretroviral clinics in Johannesburg between October 2004 and March 2007. Low birth weight ( Results Among HAART-unexposed infants, 27% (60/224 were low birth weight compared with 23% (90/388 of early HAART-exposed (exposed 3 increase, 95% CI 0.45-0.71, p 3 increase, 95% CI 0.55-0.85, p = 0.001. HAART exposure was associated with an increased preterm birth rate (15%, or 138 of 946, versus 5%, or seven of 147, in unexposed infants, p = 0.001, with early nevirapine and efavirenz-based regimens having the strongest associations with preterm birth (AOR 5.4, 95% CI 2.1-13.7, p Conclusions In this immunocompromised cohort, in utero HAART exposure was not associated with low birth weight. An association between NNRTI-based HAART and preterm birth was detected, but residual confounding is plausible. More advanced immunosuppression was a risk factor for low birth weight and preterm birth, highlighting the importance of earlier HAART initiation in women to optimize maternal health and improve infant outcomes.

  6. Circulating angiogenic factors and urinary prolactin as predictors of adverse outcomes in women with preeclampsia.

    Science.gov (United States)

    Leaños-Miranda, Alfredo; Campos-Galicia, Inova; Ramírez-Valenzuela, Karla Leticia; Chinolla-Arellano, Zarela Lizbeth; Isordia-Salas, Irma

    2013-05-01

    Preeclampsia is characterized by an imbalance in angiogenic factors. Urinary prolactin (PRL) levels and its antiangiogenic PRL fragments have been associated with disease severity. In this study, we assessed whether these biomarkers are associated with an increased risk of adverse maternal and perinatal outcomes in preeclamptic women. We studied 501 women with preeclampsia attended at a tertiary care hospital. Serum concentrations of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng), as well as urinary PRL levels, were measured by enzymed-linked immunosorbent assay. Antiangiogenic PRL fragments were determined by immunoblotting. The risk for any adverse maternal outcome and for having a small-for-gestational-age infant was higher among women with sFlt-1/PlGF ratios, sEng, and urinary PRL level values in the highest quartile (odds ratios ≥ 2.7), compared with the lowest quartile. Both urinary PRL levels and the presence of antiangiogenic PRL fragments were more closely associated with the risk of specific adverse maternal outcomes (placental abruption, hepatic hematoma or rupture, acute renal failure, pulmonary edema, maternal death, and need for endotracheal intubation, positive inotropic drug support, and hemodialysis; odds ratios ≥ 5.7 and ≥ 4.7, respectively) than either sFlt-1/PlGF ratio or sEng alone. We concluded that in preeclamptic women at the time of initial evaluation, sFlt-1/PlGF ratio and sEng are associated with increased risk of combined adverse maternal outcomes. However, urinary PRL concentrations and its antiangiogenic fragments appear to be better predictors of an adverse maternal outcome and may be useful for risk stratification in preeclampsia. PMID:23460287

  7. Frequency of adverse outcomes of acute myocardial infarction in patients with stress hyperglycem)a

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of in-hospital adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia. Methodology: This was a descriptive cross sectional study conducted from August 2010 to January 2011 in Cardiology department, Lady Reading Hospital, Peshawar. Patients of age 25-70 years, of either gender, non-diabetic with acute myocardial infarction with stress hyperglycemia were included. Random blood sugar >144 mg/dl was taken as stress hyperglycemia for patients at presentation of acute myocardial infarction. Patients were monitored for electrical complications such as atrial fibrillation, ventricular tachycardia, ventricular fibrillation and complete heart block and mechanical complications such as cardiac pulmonary edema and cardiogenic shock during hospital stay. The statistical analysis was performed using the statistical package for social sciences (SPSS Ver. 15.0). Results: A total of 341 patients having acute myocardial infarction with stress hyperglycemia were studied. The mean age was 56.35 +- 9.748 (95% CI 57.39 - 55.31). Male were 58.1% (n=198). The frequency of various major in-hospital electrical adverse outcomes of acute myocardial infarction with stress hyperglycemia were atrial fibrillation (AF) 15.8%, ventricular tachycardia (VT) 11.7%, ventricular fibrillation (VF) 10.9% and complete heart block (CHB) 6.7%, while mechanical adverse outcomes were cardiac pulmonary edema (CPE) 7.9% and cardiogenic shock (CS) 11.7%. Conclusion: Stress hyperglycemia has adverse impact on outcomes of patients presenting with acute myocardial infarction. Among electrical and mechanical complications of acute myocardial infarction in patients with stress hyperglycemia, the two most frequent in-hospital adverse outcomes were atrial fibrillation and cardiogenic shock, respectively. (author)

  8. Age of Menarche and Psychosocial Outcomes in a New Zealand Birth Cohort

    Science.gov (United States)

    Boden, Joseph M.; Fergusson, David M.; Horwood, L. John

    2011-01-01

    Objective: This study examined associations between age of menarche and psychosocial outcomes in early adulthood, including sexual behavior, mental health, criminal behavior, and education/employment, to identify the possible causal role of earlier age of menarche in increasing risks of adverse outcomes. Method: Data were gathered from 497 female…

  9. Adolescent cannabis and tobacco use and educational outcomes at age 16: birth cohort study

    OpenAIRE

    Stiby, Alexander I.; Hickman, Matthew; Munafò, Marcus R.; Heron, Jon; Yip, Vikki L.; Macleod, John

    2015-01-01

    Aims To investigate the relationship between cannabis and tobacco use by age 15 and subsequent educational outcomes. Design Birth cohort study. Setting England. Participants The sample was drawn from the Avon Longitudinal Study of Parents and Children; a core sample of 1155 individuals had complete information on all the variables. Measurements The main exposures were cannabis and tobacco use at age 15 assessed in clinic by computer-assisted questionnaire and serum cotinine. The main outcomes...

  10. Adverse Outcome Pathway for Embryonic Vascular Disruption and Alternative Methods to Identify Chemical Vascular Disruptors During Development

    Science.gov (United States)

    Chemically induced vascular toxicity during embryonic development can result in a wide range of adverse prenatal outcomes. We used information from genetic mouse models linked to phenotypic outcomes and a vascular toxicity knowledge base to construct an embryonic vascular disrupt...

  11. Maternal and Live-birth Outcomes of Pregnancies following Assisted Reproductive Technology: A Retrospective Cohort Study

    Science.gov (United States)

    Zhu, Linling; Zhang, Yu; Liu, Yifeng; Zhang, Runjv; Wu, Yiqing; Huang, Yun; Liu, Feng; Li, Meigen; Sun, Saijun; Xing, Lanfeng; Zhu, Yimin; Chen, Yiyi; Xu, Li; Zhou, Liangbi; Huang, Hefeng; Zhang, Dan

    2016-01-01

    This study was carried out to explore associations between assisted reproductive technology (ART) and maternal and neonatal outcomes compared with similar outcomes following spontaneously conceived births. We conducted a retrospective cohort study of pregnancies conceived by ART (N = 2641) during 2006–2014 compared to naturally conceived pregnancies (N = 5282) after matching for maternal age and birth year. Pregnancy complications, perinatal complications and neonatal outcomes of enrolled subjects were investigated and analysed by multivariate logistic regression. We found that pregnancies conceived by in vitro fertilization (IVF) were associated with a significantly increased incidence of gestational diabetes mellitus, gestational hypertension, preeclampsia, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, preterm premature rupture of membranes, placental adherence, postpartum haemorrhage, polyhydramnios, preterm labour, low birth weight, and small-for-date infant compared with spontaneously conceived births. Pregnancies conceived by intracytoplasmic sperm injection (ICSI) showed similar elevated complications, except some of the difference narrowed or disappeared. Singleton pregnancies or nulliparous pregnancies following ART still exhibited increased maternal and neonatal complications. Therefore, we conclude that pregnancies conceived following ART are at increased risks of antenatal complications, perinatal complications and poor neonatal outcomes, which may result from not only a higher incidence of multiple pregnancy, but also the manipulation involved in ART processes. PMID:27762324

  12. Residential Greenness and Birth Outcomes : Evaluating the Influence of Spatially Correlated Built-Environment Factors

    NARCIS (Netherlands)

    Hystad, Perry; Davies, Hugh W.; Frank, Lawrence; Loon, Josh Van; Gehring, Ulrike; Tamburic, Lillian; Brauer, Michael

    2014-01-01

    Background: Half the world’s population lives in urban areas. It is therefore important to identify characteristics of the built environment that are beneficial to human health. Urban greenness has been associated with improvements in a diverse range of health conditions, including birth outcomes; h

  13. Gender Differences in Intrahousehold Schooling Outcomes: The Role of Sibling Characteristics and Birth-Order Effects

    Science.gov (United States)

    Rammohan, Anu; Dancer, Diane

    2008-01-01

    In this paper we examine the influence of gender, sibling characteristics and birth order on the schooling attainment of school-age Egyptian children. We use multivariate analysis to simultaneously examine three different schooling outcomes of a child having "no schooling", "less than the desired level of schooling", and an "age-appropriate level…

  14. Association between maternal HBsAg carrier status and neonatal adverse outcomes: meta-analysis.

    Science.gov (United States)

    Luo, Lili; Wu, Jinlin; Qu, Yi; Li, Jiao; Pan, Lingli; Li, Deyuan; Wang, Huiqing; Mu, Dezhi

    2014-09-18

    Abstract Objective: We conducted a meta-analysis to evaluate whether maternal hepatitis B virus (HBV) carrier status increases the risk of neonatal complications. Methods: Publications addressing the association between maternal HBV carrier status and neonatal outcomes were selected from the PubMed, EMBASE, Web of Science, Cochrane Library and China National Knowledge Infrastructure. Publication bias and heterogeneity across studies were evaluated and summary odds ratios, weighted mean difference or standardized mean difference and 95% confidence intervals were calculated and compared between groups. Results: Eighteen studies and 7600 pregnant HBV carriers were selected for analyses. A statistically association with maternal HBV carrier status was demonstrated for premature birth and asphyxia, with no difference found among perinatal mortality, gestational age, small for gestational age, large for gestational age, birth weight, low birth weight, macrosomia, Apgar sore at 1 min, jaundice and congenital anomaly. Heterogeneity across studies was found, and no publication bias was detected. Conclusion: Our analysis suggests that maternal hepatitis B carrier status is significantly associated with premature birth and asphyxia. Large-scale prospective studies are still warranted. PMID:25231370

  15. Insulin resistance, adiponectin and adverse outcomes following elective cardiac surgery: a prospective follow-up study

    Directory of Open Access Journals (Sweden)

    Hjortdal Vibeke E

    2010-12-01

    Full Text Available Abstract Background Insulin resistance and adiponectin are markers of cardio-metabolic disease and associated with adverse cardiovascular outcomes. The present study examined whether preoperative insulin resistance or adiponectin were associated with short- and long-term adverse outcomes in non-diabetic patients undergoing elective cardiac surgery. Methods In a prospective study, we assessed insulin resistance and adiponectin levels from preoperative fasting blood samples in 836 patients undergoing cardiac surgery. Population-based medical registries were used for postoperative follow-up. Outcomes included all-cause death, myocardial infarction or percutaneous coronary intervention, stroke, re-exploration, renal failure, and infections. The ability of insulin resistance and adiponectin to predict clinical adverse outcomes was examined using receiver operating characteristics. Results Neither insulin resistance nor adiponectin were statistically significantly associated with 30-day mortality, but adiponectin was associated with an increased 31-365-day mortality (adjusted odds ratio 2.9 [95% confidence interval 1.3-6.4] comparing the upper quartile with the three lower quartiles. Insulin resistance was a poor predictor of adverse outcomes. In contrast, the predictive accuracy of adiponectin (area under curve 0.75 [95% confidence interval 0.65-0.85] was similar to that of the EuroSCORE (area under curve 0.75 [95% confidence interval 0.67-0.83] and a model including adiponectin and the EuroSCORE had an area under curve of 0.78 [95% confidence interval 0.68-0.88] concerning 31-365-day mortality. Conclusions Elevated adiponectin levels, but not insulin resistance, were associated with increased mortality and appear to be a strong predictor of long-term mortality. Additional studies are warranted to further clarify the possible clinical role of adiponectin assessment in cardiac surgery. Trial Registration The Danish Data Protection Agency; reference no

  16. Effects of Smoking Cessation with Voucher-Based Contingency Management on Birth Outcomes

    Science.gov (United States)

    Higgins, Stephen T.; Bernstein, Ira M.; Washio, Yukiko; Heil, Sarah H.; Badger, Gary J.; Skelly, Joan M.; Higgins, Tara M.; Solomon, Laura J.

    2010-01-01

    Introduction This study combined data from three controlled trials to examine whether smoking cessation using voucher-based contingency management (CM) improves birth outcomes. Methods Participants (N = 166) were pregnant women who participated in trials examining the efficacy of voucher-based CM for smoking cessation. Women were assigned to either a contingent condition wherein they earned vouchers exchangeable for retail items by abstaining from smoking or to a noncontingent condition where they received vouchers independent of smoking status. Birth outcomes were determined by review of hospital delivery records. Results Antepartum abstinence was greater in the contingent than noncontingent condition, with late-pregnancy abstinence being 34.1% vs. 7.4% (p < .001). Mean birth weight of infants born to mothers treated in the contingent condition was greater than infants born to mothers treated in the noncontingent condition (3295.6 ± 63.8 g vs. 3093.6 ± 67.0 g, p = .03) and the percent of low birth weight (< 2500g) deliveries was less (5.9% vs. 18.5%, p = .02). No significant treatment effects were observed across three other outcomes investigated although each was in the direction of improved outcomes in the contingent vs. the noncontingent condition: mean gestational age (39.1 ± 0.2 weeks vs. 38.5 ± 0.3 weeks, p = .06), percent of preterm deliveries (5.9 vs. 13.6, p = .09), and percent admissions to the Neonatal Intensive Care Unit (4.7% vs. 13.8%, p = .06). Conclusions These results provide evidence that smoking-cessation treatment with voucher-based CM may improve important birth outcomes. PMID:20840188

  17. Malaria infection, poor nutrition and indoor air pollution mediate socioeconomic differences in adverse pregnancy outcomes in Cape Coast, Ghana.

    Directory of Open Access Journals (Sweden)

    Adeladza K Amegah

    Full Text Available BACKGROUND: The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES. Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES. METHODS: A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire. RESULTS: In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145 reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87, low education (187 g; 95% CI: 355-20, studentship during pregnancy (291 g; 95% CI: 506-76 and low income (147 g; 95% CI: 277-17. In causal pathway analysis, malaria infection (6-20%, poor nutrition (2-51% and indoor air pollution (10-62% mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21 risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56 of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49 and 278% (RR: 3.78; 95% CI: 1.39-10.27 increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk. CONCLUSION: We provide evidence of the effects of socioeconomic deprivation

  18. Maternal reproductive experience enhances early postnatal outcome following gestation and birth of rats in hypergravity

    Science.gov (United States)

    Ronca, A. E.; Baer, L. A.; Daunton, N. G.; Wade, C. E.

    2001-01-01

    A major goal of space life sciences research is to broaden scientific knowledge of the influence of gravity on living systems. Recent spaceflight and centrifugation studies demonstrate that reproduction and ontogenesis in mammals are amenable to study under gravitational conditions that deviate considerably from those typically experienced on Earth (1 x g). In the present study, we tested the hypothesis that maternal reproductive experience determines neonatal outcome following gestation and birth under increased (hyper) gravity. Primigravid and bigravid female rats and their offspring were exposed to 1.5 x g centrifugation from Gestational Day 11 either through birth or through the first postnatal week. On the day of birth, litter sizes were identical across gravity and parity conditions, although significantly fewer live neonates were observed among hypergravity-reared litters born to primigravid dams than among those born to bigravid dams (82% and 94%, respectively; 1.0 x g controls, 99%). Within the hypergravity groups, neonatal mortality was comparable across parity conditions from Postnatal Day 1 through Day 7, at which time litter sizes stabilized. Maternal reproductive experience ameliorated neonatal losses during the first 24 h after birth but not on subsequent days, and neonatal mortality was associated with changes in maternal care patterns. These results indicate that repeated maternal reproductive experience affords protection against neonatal losses during exposure to increased gravity. Differential mortality of neonates born to primigravid versus bigravid dams denotes gravitational load as one environmental mechanism enabling the expression of parity-related variations in birth outcome.

  19. Defining the residual risk of adverse perinatal outcome in growth restricted fetuses with normal umbilical artery blood flow.

    LENUS (Irish Health Repository)

    O'Dwyer, Vicky

    2014-07-25

    To determine the cause of adverse perinatal outcome in fetal growth restriction(FGR) where umbilical artery Doppler(UA) was normal, as identified from the Prospective Observational Trial to Optimize Pediatric Health(PORTO). We compared cases of adverse outcome where UA Doppler was normal and abnormal.

  20. Adverse Pregnancy Outcomes: Opportunity for Analysis of Biospecimens and Co-development of Prognostics | NCI Technology Transfer Center | TTC

    Science.gov (United States)

    The Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Pregnancy and Perinatology Branch seeks partners interested in collaborative research to: (i) evaluate data and samples taken from women for potential biomarkers indicative for adverse pregnancy outcomes and (ii) co-develop diagnostic kits useful as predictors of adverse pregnancy outcomes.

  1. Development of computationally predicted Adverse Outcome Pathway (AOP) networks through data mining and integration of publicly available in vivo, in vitro, phenotype, and biological pathway data

    Science.gov (United States)

    The Adverse Outcome Pathway (AOP) framework is increasingly being adopted as a tool for organizing and summarizing the mechanistic information connecting molecular perturbations by environmental stressors with adverse outcomes relevant for ecological and human health outcomes. Ho...

  2. Predictors of Adverse Cosmetic Outcome in the RAPID Trial: An Exploratory Analysis

    International Nuclear Information System (INIS)

    Purpose: To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial. Methods and Materials: Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only. Results: Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients. Conclusion: In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment

  3. Predictors of Adverse Cosmetic Outcome in the RAPID Trial: An Exploratory Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, David; Truong, Pauline T. [Vancouver Island Centre, British Columbia Cancer Agency, Victoria, British Columbia (Canada); Parpia, Sameer [Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario (Canada); Olivotto, Ivo A. [Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada); Berrang, Tanya [Vancouver Island Centre, British Columbia Cancer Agency, Victoria, British Columbia (Canada); Kim, Do-Hoon; Kong, Iwa [Juravinski Cancer Centre at Hamilton Health Sciences, McMaster University, Hamilton, Ontario (Canada); Germain, Isabelle [Centre Hospitalier Universitaire de Québec, Pavillon Hôtel-Dieu de Quebec, Quebec City, Québec (Canada); Nichol, Alan [Vancouver Centre, British Columbia Cancer Agency, Vancouver, British Columbia (Canada); Akra, Mohamed [CancerCare Manitoba, Winnipeg, Manitoba (Canada); Roy, Isabelle [Centre intégré de cancérologie de Laval, Laval, Québec (Canada); Reed, Melanie [Center for the Southern Interior, British Columbia Cancer Agency, Kelowna, British Columbia (Canada); Fyles, Anthony [University Health Network, Princess Margaret Hospital, Toronto, Ontario (Canada); Trotter, Theresa [Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada); Perera, Francisco [London Regional Cancer Centre, London, Ontario (Canada); Balkwill, Susan [Fraser Valley Centre, British Columbia Cancer Agency, Surrey, British Columbia (Canada); Lavertu, Sophie [Centre Hospitalier de l' Université de Montréal, Hôpital Notre-Dame, Montreal, Québec (Canada); Elliott, Elizabeth [Juravinski Cancer Centre at Hamilton Health Sciences, McMaster University, Hamilton, Ontario (Canada); and others

    2015-04-01

    Purpose: To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial. Methods and Materials: Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only. Results: Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients. Conclusion: In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment

  4. Blood carbon dioxide levels and adverse outcome in neonatal hypoxic-ischemic encephalopathy.

    LENUS (Irish Health Repository)

    Nadeem, Montasser

    2012-01-31

    We investigated pCO(2) patterns and the relationship between pCO(2) levels and neurodevelopmental outcome in term infants with hypoxic-ischemic encephalopathy. Blood gases during the first 72 hours of life were collected from 52 infants with hypoxic-ischemic encephalopathy. Moderate hypocapnia (pCO(2) <3.3 kPa), severe hypocapnia (pCO(2) <2.6 kPa), and hypercapnia (pCO(2) >6.6 kPa) were correlated to neurodevelopmental outcome at 24 months. Normocapnia was documented in 416\\/551 (75.5%) of samples and was present during the entire 72 hours in only 6 out of 52 infants. Mean (standard deviation) pCO(2) values did not differ between infants with normal and abnormal outcomes: 5.43 (2.4) and 5.41 (2.03), respectively. There was no significant association between moderate hypocapnia, severe hypocapnia, or hypercapnia and adverse outcome (odds ratio [OR] = 1.84, 95% confidence interval [CI] = 0.49 to 6.89; OR = 3.16, CI = 0.14 to 28.45; and OR = 1.07, CI = 0.24 to 5.45, respectively). In conclusion, only one in nine newborns had normocapnia throughout the first 72 hours. Severe hypocapnia was rare and occurred only in ventilated babies. Hypercapnia and hypocapnia in infants with hypoxic-ischemic encephalopathy during the first 72 hours of life were not associated with adverse outcome.

  5. Pregnancy outcomes among female hairdressers who participated in the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Zhu, Jin Liang; Vestergaard, Mogens; Hjøllund, Niels Henrik Ingvar;

    2006-01-01

    , gender ratio, preterm birth, small-for-gestational age, congenital malformations, or achievement of developmental milestones among the children of hairdressers and shop assistants. CONCLUSIONS: The results do not indicate that children of hairdressers in Denmark currently have a high risk of fetal...... the Danish National Birth Cohort between 1997 and 2003. Information on job characteristics was reported by the women in the first interview (around 17 weeks of gestation). Pregnancy outcomes were obtained by linkage to the national registers. Developmental milestones were reported by the mother at the fourth...

  6. Predicting adverse obstetric outcome after early pregnancy events and complications: a review.

    Science.gov (United States)

    van Oppenraaij, R H F; Jauniaux, E; Christiansen, O B; Horcajadas, J A; Farquharson, R G; Exalto, N

    2009-01-01

    BACKGROUND The aim was to evaluate the impact of early pregnancy events and complications as predictors of adverse obstetric outcome. METHODS We conducted a literature review on the impact of first trimester complications in previous and index pregnancies using Medline and Cochrane databases covering the period 1980-2008. RESULTS Clinically relevant associations of adverse outcome in the subsequent pregnancy with an odds ratio (OR) > 2.0 after complications in a previous pregnancy are the risk of perinatal death after a single previous miscarriage, the risk of very preterm delivery (VPTD) after two or more miscarriages, the risk of placenta praevia, premature preterm rupture of membranes, VPTD and low birthweight (LBW) after recurrent miscarriage and the risk of VPTD after two or more termination of pregnancy. Clinically relevant associations of adverse obstetric outcome in the ongoing pregnancy with an OR > 2.0 after complications in the index pregnancy are the risk of LBW and very low birthweight (VLBW) after a threatened miscarriage, the risk of pregnancy-induced hypertension, pre-eclampsia, placental abruption, preterm delivery (PTD), small for gestational age and low 5-min Apgar score after detection of an intrauterine haematoma, the risk of VPTD and intrauterine growth restriction after a crown-rump length discrepancy, the risk of VPTD, LBW and VLBW after a vanishing twin phenomenon and the risk of PTD, LBW and low 5-min Apgar score in a pregnancy complicated by severe hyperemesis gravidarum. CONCLUSIONS Data from our literature review indicate, by finding significant associations, that specific early pregnancy events and complications are predictors for subsequent adverse obstetric and perinatal outcome. Though, some of these associations are based on limited or small uncontrolled studies. Larger population-based controlled studies are needed to confirm these findings. Nevertheless, identification of these risks will improve obstetric care. PMID:19270317

  7. Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs

    OpenAIRE

    Le Nhu D; Teschke Kay; Chow Yat; Lorenzi Maria; Beking Kris; Spinelli John J; Ratner Pamela A; Gallagher Richard P; Dimich-Ward Helen

    2010-01-01

    Abstract Background To determine the relationships of potential occupational exposure to antineoplastic drugs with cancer incidence and adverse pregnancy outcomes in a historical prospective cohort study of female registered nurses (RNs) from British Columbia, Canada (BC). Methods Female RNs registered with a professional regulatory body for at least one year between 1974 and 2000 formed the cohort (n = 56,213). The identifier file was linked to Canadian cancer registries. An RN offspring coh...

  8. TLR-9 Activation Coupled To IL-10 Deficiency Induces Adverse Pregnancy Outcomes

    OpenAIRE

    Thaxton, Jessica E.; Romero, Roberto; Sharma, Surendra

    2009-01-01

    Pregnancy outcome is severely compromised by intrauterine infections and inflammation. Although the pregnant uterine microenvironment is replete with innate immune cells and Toll-like receptor (TLR) expression, the mechanisms that facilitate adverse effects of their activation are largely unknown. Here we mimic the activation of TLR-9 with its pathogenic ligand hypomethylated CpG, and demonstrate that IL-10 proficiency protects against CpG-induced pregnancy complications. We show that fetal r...

  9. MATERNAL AND FOETAL OUTCOME OF VAGINAL BIRTH AFTER CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Thulasi

    2016-04-01

    Full Text Available OBJECTIVES OF THE STUDY 1. To identify maternal and foetal factors responsible for the success or the failure of VBAC. 2. To study maternal and perinatal outcome while giving a trial of scar. METHOD OF COLLECTION OF DATA Study was conducted at P K Das Institute of Medical Sciences hospital. 50 cases obtained during the period of January 2013 to December 2013 were studied. Inclusion Criteria 1. Multigravida with previous one lower segment caesarean section at term in early labour. 2. Singleton pregnancy. 3. Cephalic presentation. 4. Who are willing for VBAC. 5. Well-informed subjects. Exclusion Criteria 1. Known classical scar and 2 or >caesarean sections. 2. Unknown uterine scar. 3. Multiple gestation. 4. Malpresentations. 5. Cephalopelvic disproportion. 6. Subjects with medical complication/obstetric risk factors. Cases are monitored with a partogram and continuous foetal monitor. METHODOLOGY Informed consent is taken after explaining the risks, benefits and potential complications in patients’ own language while giving a trial of scar. After the exclusion criteria, patients selected for VBAC is given a trial of scar. 1. Maternal monitoring of blood pressure and pulse rate every 15 minutes is done. 2. Continuous foetal monitoring in the active phase of labour. 3. Contraction stress test will be done in the active phase of labour. Uterine contractions are monitored every 30 minutes. Partogram is used to ensure adequate progress with respect to descent of the head, cervical dilatation, moulding and caput. 4. Pelvic examination every one hour to assess the progress of labour. 5. If labour has to be induced, done with great care particularly with prostaglandins – PGE 2 gel. Progress of labour should be assessed by a senior obstetrician, particularly in an unfavourable cervix. 6. Cross-matched blood is kept ready and a good intravenous line is established. 7. Oxytocin may be used with caution, as in any labour, for induction or augmentation. 8

  10. Prolonged time to pregnancy is associated with a greater risk of adverse outcomes.

    Science.gov (United States)

    Raatikainen, Kaisa; Harju, Maija; Hippeläinen, Maritta; Heinonen, Seppo

    2010-08-01

    Births with known time to pregnancy (TTP) during the period 1989-2007 (n=17,114) were analyzed to investigate associations between TTP and pregnancy outcome among couples that conceived spontaneously. The adjusted odds ratio (95% confidence interval) for poor neonatal health, including low Apgar score, low umbilical vein pH, and need for neonatal intensive care, was 1.51 (1.09-2.09) in women who had a TTP of 25-36 months and 1.60 (1.18-2.19) in women who had a TTP of >or=37 months compared with women with a TTP of 0-6 months.

  11. Laboratory work and pregnancy outcomes: a study within the National Birth Cohort in Denmark

    Science.gov (United States)

    Zhu, J L; Knudsen, L E; Andersen, A‐M N; Hjollund, N H; Olsen, J

    2006-01-01

    Aims To examine pregnancy outcomes in women doing laboratory work. Methods Using data from the Danish National Birth Cohort (1997–2003), the authors conducted a prospective cohort study of 1025 female laboratory technicians and 8037 female teachers (as reference). The laboratory technicians were asked about laboratory work tasks during pregnancy in an interview (at around 16 weeks of gestation). Pregnancy outcomes were obtained by linking the cohort to the national registers. Hazard ratios (HRs) of late fetal loss and diagnosing of congenital malformations were calculated by using Cox regression, and odds ratios (ORs) of preterm birth and small for gestational age were calculated by using logistic regression. Results Overall, there were no significant differences in pregnancy outcomes between laboratory technicians and teachers. However, we found that laboratory technicians working with radioimmunoassay or radiolabelling had an increased risk of preterm birth (OR = 2.2, 95% CI 0.8 to 6.2 for radioimmunoassay, and OR = 1.9, 95% CI 0.8 to 4.6 for radiolabelling) and “major” malformations (HR = 2.1, 95% CI 1.0 to 4.7 for radioimmunoassay, and HR = 1.8, 95% CI 0.9 to 3.7 for radiolabelling). The ORs of preterm birth doubled for women working with these tasks every day or several times a week. When an exposure matrix was applied, an increased risk of “major” malformations for exposure to organic solvents was seen. Conclusions The results did not indicate any high risk of reproductive failures in laboratory technicians in general. Exposure to radioisotopes may carry a high risk of preterm birth and congenital malformations. This finding deserves further investigation. PMID:16361406

  12. SOCIODEMOGRAPHIC DOAMINS OF DEPRIVATION AND PRETERM BIRTH

    Science.gov (United States)

    Background. Neighborhood-level deprivation has long been associated with adverse outcomes, including preterm birth (PTB), as observed in the authors' previous work using a composite deprivation index. Area disadvantage is multifaceted comprising income, employment, education and...

  13. Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease.

    Directory of Open Access Journals (Sweden)

    James A G Crispo

    Full Text Available Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD. The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population.Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS. Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits.Many individuals (57.8% were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (≥ 4 were more likely to be diagnosed with fractures (adjusted odds ratio (AOR: 1.56, 95% CI: 1.29-1.88 and delirium (AOR: 1.61, 95% CI: 1.08-2.40 relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR: 1.32, 95% CI: 1.10-1.58 and be readmitted (AHR: 1.16, 95% CI: 1.01-1.33 within 30-days of discharge.We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. Additional pharmacovigilance studies are needed to better understand risks associated with anticholinergic medication use in PD.

  14. Vitamin D Deficiency Increases the Risk of Adverse Neonatal Outcomes in Gestational Diabetes

    Science.gov (United States)

    Weinert, Letícia Schwerz; Reichelt, Angela Jacob; Schmitt, Leonardo Rauber; Boff, Roberta; Oppermann, Maria Lucia Rocha; Camargo, Joiza Lins; Silveiro, Sandra Pinho

    2016-01-01

    Background Gestational diabetes mellitus (GDM) and vitamin D deficiency have been associated with increased risk of adverse perinatal outcomes but the consequences of both conditions simultaneously present in pregnancy have not yet been evaluated. Our objective was to study the influence of vitamin D deficiency in neonatal outcomes of pregnancies with GDM. Methods 184 pregnant women with GDM referred to specialized prenatal monitoring were included in this cohort and had blood sampled for 25-hydroxyvitamin D measurement. Vitamin D was measured by chemiluminescence and deficiency was defined as < 20 ng/mL. Participants were followed until puerperium and adverse neonatal outcomes were evaluated. Results Newborns of women with vitamin D deficiency had higher incidences of hospitalization in intensive care units (ICU) (32 vs 19%, P = 0.048), of hypoglycemia (any, 17.3 vs 7.1%, P = 0.039requiring ICU, 15.3 vs 3.6%, P = 0.008), and were more frequently small for gestational age (SGA) (17.3 vs 5.9%, P = 0.017). After adjustment, relative risk (RR) for hypoglycemia requiring ICU was 3.63 (95%CI 1.09–12.11) and for SGA was 4.32 (95%CI 1.75–10.66). The incidence of prematurity, jaundice and shoulder dystocia was no statistically different between groups. Conclusions In this cohort of pregnant women with GDM, vitamin D deficiency was associated with a major increase in the incidence of adverse neonatal outcomes such as SGA newborns and neonatal hypoglycemia. PMID:27764194

  15. Birth Weight Ratio as an Alternative to Birth Weight Percentile to Express Infant Weight in Research and Clinical Practice: A Nationwide Cohort Study

    Science.gov (United States)

    Kazemier, Brenda M.; Schuit, Ewoud; Mol, Ben Willem J.; Pajkrt, Eva; Ganzevoort, Wessel

    2014-01-01

    Objective. To compare birth weight ratio and birth weight percentile to express infant weight when assessing pregnancy outcome. Study Design. We performed a national cohort study. Birth weight ratio was calculated as the observed birth weight divided by the median birth weight for gestational age. The discriminative ability of birth weight ratio and birth weight percentile to identify infants at risk of perinatal death (fetal death and neonatal death) or adverse pregnancy outcome (perinatal death + severe neonatal morbidity) was compared using the area under the curve. Outcomes were expressed stratified by gestational age at delivery separate for birth weight ratio and birth weight percentile. Results. We studied 1,299,244 pregnant women, with an overall perinatal death rate of 0.62%. Birth weight ratio and birth weight percentile have equivalent overall discriminative performance for perinatal death and adverse perinatal outcome. In late preterm infants (33+0–36+6 weeks), birth weight ratio has better discriminative ability than birth weight percentile for perinatal death (0.68 versus 0.63, P  0.01) or adverse pregnancy outcome (0.67 versus 0.60, P < 0.001). Conclusion. Birth weight ratio is a potentially valuable instrument to identify infants at risk of perinatal death and adverse pregnancy outcome and provides several advantages for use in research and clinical practice. Moreover, it allows comparison of groups with different average birth weights. PMID:25197283

  16. A prospective study of effects of psychological factors and sleep on obstetric interventions, mode of birth, and neonatal outcomes among low-risk British Columbian women

    Directory of Open Access Journals (Sweden)

    Hall Wendy A

    2012-08-01

    Full Text Available Abstract Background Obstetrical interventions, including caesarean sections, are increasing in Canada. Canadian women’s psychological states, fatigue, and sleep have not been examined prospectively for contributions to obstetric interventions and adverse neonatal outcomes. Context and purpose of the study: The prospective study was conducted in British Columbia (BC, Canada with 650 low-risk pregnant women. Of those women, 624 were included in this study. Women were recruited through providers’ offices, media, posters, and pregnancy fairs. We examined associations between pregnant women’s fatigue, sleep deprivation, and psychological states (anxiety and childbirth fear and women’s exposure to obstetrical interventions and adverse neonatal outcomes (preterm, admission to NICU, low APGARS, and low birth weight. Methods Data from our cross-sectional survey were linked, using women’s personal health numbers, to birth outcomes from the Perinatal Services BC database. After stratifying for parity, we used Pearson’s Chi-square to examine associations between psychological states, fatigue, sleep deprivation and maternal characteristics. We used hierarchical logistic regression modeling to test 9 hypotheses comparing women with high and low childbirth fear and anxiety on likelihood of having epidural anaesthetic, a caesarean section (stratified for parity, assisted vaginal delivery, and adverse neonatal outcomes and women with and without sleep deprivation and high levels of fatigue on likelihood of giving birth by caesarean section, while controlling for maternal, obstetrical (e.g., infant macrosomia, and psychological variables. Results Significantly higher proportions of multiparas, reporting difficult and upsetting labours and births, expectations of childbirth interventions, and health stressors, reported high levels of childbirth fear. Women who reported antenatal relationship, housing, financial, and health stressors and multiparas

  17. Five year outcome of preterm sextuplets related to size at birth.

    OpenAIRE

    Marlow, N; Ellis, A. M.; Roberts, B. L.; Cooke, R W

    1990-01-01

    Preterm sextuplets were studied to examine whether growth retardation affects long term outcome. All were growing normally at 5 years. Intelligence quotients (IQ) ranged from 105-116 and motor impairment scores from 1.0-7.0. No neurological or behavioural abnormalities were found. The largest sextuplet has maintained her position for growth and IQ. No relation between test scores and birth weight or perinatal variables was found in the remaining siblings.

  18. Comparison between the Outcomes of Water Birth and Normal Vaginal Delivery

    OpenAIRE

    Mitra Kolivand; Afshin Almasi; Sousan Heydarpour

    2014-01-01

    Background & aim: Warm water immersion during labor is associated with relaxation and pain reduction for pregnant women. This method is not extensively used in Iran, given the fear of infection and other maternal/neonatal complications. Alternative methods are required to increase the safety of normal vaginal delivery. The purpose of this study was to compare maternal and neonatal outcomes, associated with water birth and normal vaginal delivery. Methods:This analytical, cross-sectional study...

  19. Progestogens to prevent preterm birth in twin pregnancies

    DEFF Research Database (Denmark)

    Schuit, Ewoud; Stock, Sarah; Groenwold, Rolf H H;

    2012-01-01

    Preterm birth is the principal factor contributing to adverse outcomes in multiple pregnancies. Randomized controlled trials of progestogens to prevent preterm birth in twin pregnancies have shown no clear benefits. However, individual studies have not had sufficient power to evaluate potential...... benefits in women at particular high risk of early delivery (for example, women with a previous preterm birth or short cervix) or to determine adverse effects for rare outcomes such as intrauterine death....

  20. Maternal care and birth outcomes among ethnic minority women in Finland

    Directory of Open Access Journals (Sweden)

    Gissler Mika

    2009-03-01

    Full Text Available Abstract Background Care during pregnancy and labour is of great importance in every culture. Studies show that people of migrant origin have barriers to obtaining accessible and good quality care compared to people in the host society. The aim of this study is to compare the access to and use of maternity services, and their outcomes among ethnic minority women having a singleton birth in Finland. Methods The study is based on data from the Finnish Medical Birth Register in 1999–2001 linked with the information of Statistics Finland on woman's country of birth, citizenship and mother tongue. Our study data included 6,532 women of foreign origin (3.9% of all singletons giving singleton birth in Finland during 1999–2001 (compared to 158,469 Finnish origin singletons. Results Most women have migrated during the last fifteen years, mainly from Russia, Baltic countries, Somalia and East Europe. Migrant origin women participated substantially in prenatal care. Interventions performed or needed during pregnancy and childbirth varied between ethnic groups. Women of African and Somali origin had most health problems resulted in the highest perinatal mortality rates. Women from East Europe, the Middle East, North Africa and Somalia had a significant risk of low birth weight and small for gestational age newborns. Most premature newborns were found among women from the Middle East, North Africa and South Asia. Primiparous women from Africa, Somalia and Latin America and Caribbean had most caesarean sections while newborns of Latin American origin had more interventions after birth. Conclusion Despite good general coverage of maternal care among migrant origin women, there were clear variations in the type of treatment given to them or needed by them. African origin women had the most health problems during pregnancy and childbirth and the worst perinatal outcomes indicating the urgent need of targeted preventive and special care. These study results

  1. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Keeling, Aoife N.; Khalidi, Karim; Leong, Sum [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Wang, Tim T. [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Ayyoub, Alaa S.; McGrath, Frank P. [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Athanasiou, Thanos [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Lee, Michael J., E-mail: mlee@rcsi.ie [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland)

    2011-03-15

    Aim: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). Materials and methods: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. Results: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). Conclusion: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  2. Below knee angioplasty in elderly patients: predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2012-02-01

    AIM: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). MATERIALS AND METHODS: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. RESULTS: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). CONCLUSION: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  3. Adverse Geriatric Outcomes Secondary to Polypharmacy in a Mouse Model: The Influence of Aging.

    Science.gov (United States)

    Huizer-Pajkos, Aniko; Kane, Alice E; Howlett, Susan E; Mach, John; Mitchell, Sarah J; de Cabo, Rafael; Le Couteur, David G; Hilmer, Sarah N

    2016-05-01

    We aimed to develop a mouse model of polypharmacy, primarily to establish whether short-term exposure to polypharmacy causes adverse geriatric outcomes. We also investigated whether old age increased susceptibility to any adverse geriatric outcomes of polypharmacy. Young (n= 10) and old (n= 21) male C57BL/6 mice were administered control diet or polypharmacy diet containing therapeutic doses of five commonly used medicines (simvastatin, metoprolol, omeprazole, acetaminophen, and citalopram). Mice were assessed before and after the 2- to 4-week intervention. Over the intervention period, we observed no mortality and no change in food intake, body weight, or serum biochemistry in any age or treatment group. In old mice, polypharmacy caused significant declines in locomotor activity (pre minus postintervention values in control 2 ± 13 counts, polypharmacy 32 ± 7 counts,p< .05) and front paw wire holding impulse (control -2.45 ± 1.02 N s, polypharmacy +1.99 ± 1.19 N s,p< .05), loss of improvement in rotarod latency (control -59 ± 11 s, polypharmacy -1.7 ± 17 s,p< .05), and lowered blood pressure (control -0.2 ± 3 mmHg, polypharmacy 11 ± 4 mmHg,p< .05). In young mice, changes in outcomes over the intervention period did not differ between control and polypharmacy groups. This novel model of polypharmacy is feasible. Even short-term polypharmacy impairs mobility, balance, and strength in old male mice. PMID:25940962

  4. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes

    International Nuclear Information System (INIS)

    Aim: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). Materials and methods: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. Results: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). Conclusion: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  5. Defining and Modeling Known Adverse Outcome Pathways: Domoic Acid and Neuronal Signaling as a Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Karen H.; Andersen, Melvin E.; Basu, Nil; Carvan, Michael J.; Crofton, Kevin M.; King, Kerensa A.; Sunol, Cristina; Tiffany-Castiglioni, Evelyn; Schultz, Irvin R.

    2011-01-01

    An adverse outcome pathway (AOP) is a sequence of key events from a molecular-level initiating event and an ensuing cascade of steps to an adverse outcome with population level significance. To implement a predictive strategy for ecotoxicology, the multiscale nature of an AOP requires computational models to link salient processes (e.g., in chemical uptake, toxicokinetics, toxicodynamics, and population dynamics). A case study with domoic acid was used to demonstrate strategies and enable generic recommendations for developing computational models in an effort to move toward a toxicity testing paradigm focused on toxicity pathway perturbations applicable to ecological risk assessment. Domoic acid, an algal toxin with adverse effects on both wildlife and humans, is a potent agonist for kainate receptors (ionotropic glutamate receptors whose activation leads to the influx of Na+ and Ca2+). Increased Ca2+ concentrations result in neuronal excitotoxicity and cell death primarily in the hippocampus, which produces seizures, impairs learning and memory, and alters behavior in some species. Altered neuronal Ca2+ is a key process in domoic acid toxicity which can be evaluated in vitro. Further, results of these assays would be amenable to mechanistic modeling for identifying domoic acid concentrations and Ca2+ perturbations that are normal, adaptive, or clearly toxic. In vitro assays with outputs amenable to measurement in exposed populations can link in vitro to in vivo conditions, and toxicokinetic information will aid in linking in vitro results to the individual organism. Development of an AOP required an iterative process with three important outcomes: (1) a critically reviewed, stressor-specific AOP; (2) identification of key processes suitable for evaluation with in vitro assays; and (3) strategies for model development.

  6. Effect of RAAS blockers on adverse clinical outcomes in high CVD risk subjects with atrial fibrillation

    Science.gov (United States)

    Chaugai, Sandip; Sherpa, Lhamo Yanchang; Sepehry, Amir A.; Arima, Hisatomi; Wang, Dao Wen

    2016-01-01

    Abstract Recent studies have demonstrated that atrial fibrillation significantly increases the risk of adverse clinical outcomes in high cardiovascular disease risk subjects. Application of renin–angiotensin–aldosterone system blockers for prevention of recurrence of atrial fibrillation and adverse clinical outcomes in subjects with atrial fibrillation is a theoretically appealing concept. However, results of clinical trials evaluating the effect of renin–angiotensin–aldosterone blockers on adverse clinical outcomes in high cardiovascular disease risk subjects with atrial fibrillation remain inconclusive. A pooled study of 6 randomized controlled trials assessing the efficacy of renin–angiotensin–aldosterone blockers on subjects with atrial fibrillation was performed. A total of 6 randomized controlled trials enrolled a total of 53,510 patients followed for 1 to 5 years. RAAS blockade therapy was associated with 14% reduction in the incidence of heart failure (OR: 0.86, [95%CI: 0.76– 0.97], P=0.018) and 17% reduction in the incidence of CVE (OR: 0.83, [95%CI: 0.70–0.99], P = 0.038). The corresponding decline in absolute risk against heart failure (ARR: 1.4%, [95%CI: 0.2–2.6%], P = 0.018) and CVE (ARR: 3.5%, [95%CI: 0.0–6.9%], P = 0.045) in the AF group was much higher than the non-AF group for heart failure (ARR: 0.4%, [95%CI: 0.0–0.7%], P = 0.057) and CVE (ARR: 1.6%, [95%CI: –0.1% to 3.3%], P = 0.071). No significant effect was noted on all-cause or cardiovascular mortality, stroke, or myocardial infarction. This study suggests that RAAS blockade offers protection against heart failure and cardiovascular events in high cardiovascular disease risk subjects with atrial fibrillation. PMID:27368043

  7. Methodological challenges when estimating the effects of season and seasonal exposures on birth outcomes

    Directory of Open Access Journals (Sweden)

    Tong Shilu

    2011-04-01

    Full Text Available Abstract Background Many previous studies have found seasonal patterns in birth outcomes, but with little agreement about which season poses the highest risk. Some of the heterogeneity between studies may be explained by a previously unknown bias. The bias occurs in retrospective cohorts which include all births occurring within a fixed start and end date, which means shorter pregnancies are missed at the start of the study, and longer pregnancies are missed at the end. Our objective was to show the potential size of this bias and how to avoid it. Methods To demonstrate the bias we simulated a retrospective birth cohort with no seasonal pattern in gestation and used a range of cohort end dates. As a real example, we used a cohort of 114,063 singleton births in Brisbane between 1 July 2005 and 30 June 2009 and examined the bias when estimating changes in gestation length associated with season (using month of conception and a seasonal exposure (temperature. We used survival analyses with temperature as a time-dependent variable. Results We found strong artificial seasonal patterns in gestation length by month of conception, which depended on the end date of the study. The bias was avoided when the day and month of the start date was just before the day and month of the end date (regardless of year, so that the longer gestations at the start of the study were balanced by the shorter gestations at the end. After removing the fixed cohort bias there was a noticeable change in the effect of temperature on gestation length. The adjusted hazard ratios were flatter at the extremes of temperature but steeper between 15 and 25°C. Conclusions Studies using retrospective birth cohorts should account for the fixed cohort bias by removing selected births to get unbiased estimates of seasonal health effects.

  8. Effect of Prenatal Polycyclic Aromatic Hydrocarbons Exposure on Birth Outcomes: The Polish Mother and Child Cohort Study

    Directory of Open Access Journals (Sweden)

    Kinga Polanska

    2014-01-01

    Full Text Available The aim of this study was to assess the impact of PAH exposure on various anthropometric measures of birth outcomes. The study population consisted of 210 nonsmoking pregnant women. Urine samples collected between 20th and 24th week of pregnancy were used for analysis of the following PAH metabolites: 1-, 2-, 3-, 4-, and 9-hydroxyphenanthrene (1-, 2-, 3-, 4-, and 9-OH-PHE, 1-hydroxypyrene (1-OH-PYR, 1,6 + 1,8-dihydroxypyrene (DI-OH-PYR, phenanthrene trans-1,2-dihydrodiol (PHE-1,2-diol, and phenanthrene trans-9,10-dihydrodiol (PHE-9,10-diol by gas chromatography-mass spectrometry. Environmental tobacco smoke exposure (ETS was assessed by cotinine level in saliva using a stable isotope dilution LC-ESI-MS/MS method. The mean PAH metabolite concentrations were in the range of 0.15 µg/g creatinine for 9-OH-PHE to 5.9 µg/g creatinine for PHE-9,10-diol. It was shown that none of the individual PAH exposure markers demonstrate a statistically significant influence on birth outcomes. Interestingly a statistically significant association was found between the sum of OH-PHE along with cotinine level and the cephalization index after adjusting for potential confounders (P=0.04. This study provides evidence that combined exposure of pregnant women to common environmental pollutants such as PAH and ETS might adversely affect fetal development. Thus, reduction of human exposure to these mixtures of hazardous compounds would in particular result in substantial health benefits for newborns.

  9. Predicting Adverse Health Outcomes in Long-Term Survivors of a Childhood Cancer

    Directory of Open Access Journals (Sweden)

    Chaya S. Moskowitz

    2014-07-01

    Full Text Available More than 80% of children and young adults diagnosed with invasive cancer will survive five or more years beyond their cancer diagnosis. This population has an increased risk for serious illness- and treatment-related morbidity and premature mortality. A number of these adverse health outcomes, such as cardiovascular disease and some second primary neoplasms, either have modifiable risk factors or can be successfully treated if detected early. Absolute risk models that project a personalized risk of developing a health outcome can be useful in patient counseling, in designing intervention studies, in forming prevention strategies, and in deciding upon surveillance programs. Here, we review existing absolute risk prediction models that are directly applicable to survivors of a childhood cancer, discuss the concepts and interpretation of absolute risk models, and examine ways in which these models can be used applied in clinical practice and public health.

  10. Birth outcomes of patients with isolated anorectal malformations: A population-based case-control study.

    Science.gov (United States)

    Vermes, Gabor; László, Daniel; Czeizel, Andrew E; Ács, Nándor

    2016-01-01

    In most patients affected by isolated anorectal malformation (IARM) the etiology is largely unknown. Thus, the aim of our project was to analyze possible risk factors for IARM. In the first step, birth outcomes of cases with IARM were analyzed on the basis of maternal socio-demographic variables, and these data are presented in this paper. Gestational age at delivery, birthweight, preterm birth, low birthweight and small for gestational age of cases with IARM were evaluated in the function of maternal age, birth/pregnancy order, marital and employment status of mothers in the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996. The study samples included 231 live-born cases with IARM, 361 matched and 38 151 population controls without any defect. IARMs are more frequent in males, twins and newborn infants with low birthweight and small-for-gestational-age, the latter being the consequence of intrauterine growth restriction. In addition, mothers of cases were younger but with higher birth order, and had lower socio-economic status. These maternal variables are characteristic for the gypsy population in Hungary. The higher proportion of gypsy women among the mothers of cases with IARM was confirmed during the home visits of the study. Male sex and intrauterine growth restriction of cases, in addition to low socioeconomic status and gypsy origin of mothers may have a role in the risk of IARMs. PMID:26259501

  11. Conceptual Model for Assessing Criteria Air Pollutants in a Multipollutant Context: A Modified Adverse Outcome Pathway Approach

    Science.gov (United States)

    Background: Air pollution consists of a complex mixture of particulate and gaseous components. Individual criteria and other hazardous air pollutants have been linked to adverse respiratory and cardiovascular health outcomes. However, assessing risk of air pollutant mixtures is d...

  12. Fetal growth and adverse birth outcomes in women receiving prescriptions for acetaminophen during pregnancy

    DEFF Research Database (Denmark)

    Thulstrup, Ane Marie; Sørensen, Henrik Toft; Nielsen, Gunnar Lauge;

    1999-01-01

    We studied the association between acetaminophen exposure during pregnancy and the prevalence of congenital abnormalities and fetal growth. Our study included 123 women who had received a prescription of acetaminophen during pregnancy and/or 30 days before conception and 13,329 controls who did n...

  13. Iron overload in very low birth weight infants: Serum Ferritin and adverse outcomes

    LENUS (Irish Health Repository)

    Barrett, M

    2011-11-01

    Adequate iron isessential for growth and haematpoiesis. Oral iron supplementation is the standard of care in VLBW infants. Post mortem evidence has confirmed significant iron overload. Excessive free iron has been associated with free radical formation and brain injury in term infants.

  14. [Effect of high altitude on birth weight and adverse perinatal outcomes in two Argentine populations].

    Science.gov (United States)

    Grandi, Carlos; Dipierri, José; Luchtenberg, Guillermo; Moresco, Angélica; Alfaro, Emma

    2013-01-01

    Introducción: existe poca información sobre la relación entre tamaño al nacer y altura geográfica ajustada para factores maternos y obstétricos potencialmente confusores. Objetivo: analizar la variación, en función de la altitud geográfica, del Peso al Nacimiento (PN) y resultados perinatales adversos, en dos poblaciones argentinas. Material y Métodos: 4000 registros de recién nacidos (RN) de Jujuy y 4000 de Buenos Aires (Maternidad Sardá) (1996-2000), seleccionados y aleatorizados del Sistema Informático Perinatal. Los datos provenían de la Maternidad Sarda (20 msnm) y las regiones jujeñas: Ramal (500 msnm), Valle (1200 msnm), Quebrada (2500 msnm) y Puna (3500 msnm). Variables resultado: PN >3000 g, PN 3000 g, PN enfermedades crónicas no transmisibles, se debería evaluar esta relación en otras poblaciones, independientemente de su localización altitudinal.

  15. Maternal Snoring May Predict Adverse Pregnancy Outcomes: A Cohort Study in China.

    Directory of Open Access Journals (Sweden)

    Xing Ge

    Full Text Available To examine the prevalence of snoring during pregnancy and its effects on key pregnancy outcomes.Pregnant women were consecutively recruited in their first trimester. Habitual snoring was screened by using a questionnaire in the 1st and 3rd trimester, respectively. According to the time of snoring, participants were divided into pregnancy onset snorers, chronic snorers and non-snorers. Logistic regressions were performed to examine the associations between snoring and pregnancy outcomes.Of 3 079 pregnant women, 16.6% were habitual snorers, with 11.7% were pregnancy onset snorers and 4.9% were chronic snorers. After adjusting for potential confounders, chronic snorers were independently associated with gestational diabetes mellitus (GDM (RR 1.66, 95%CI 1.09-2.53. Both pregnancy onset and chronic snorers were independently associated with placental adhesion (RR 1.96, 95%CI 1.17-3.27, and RR 2.33, 95%CI 1.22-4.46, respectively. Pregnancy onset snorers were at higher risk of caesarean delivery (RR 1.37, 95%CI 1.09-1.73 and having macrosomia (RR 1.54, 95%CI 1.05-2.27 and large for gestational age (LGA (RR 1.71, 95%CI 1.31-2.24 infants. In addition, being overweight or obese before pregnancy plays an important role in mediating snoring and adverse pregnancy outcomes.Maternal snoring may increase the risk of adverse pregnancy outcomes, and being overweight or obese before pregnancy with snoring is remarkable for researchers. Further studies are still needed to confirm our results.

  16. Generation of computationally predicted Adverse Outcome Pathway networks through integration of publicly available in vivo, in vitro, phenotype, and biological pathway data.

    Science.gov (United States)

    The Adverse Outcome Pathway (AOP) framework is becoming a widely used tool for organizing and summarizing the mechanistic information connecting molecular perturbations by environmental stressors with adverse ecological and human health outcomes. However, the conventional process...

  17. Should we continue using amphotericin B deoxycholate for the treatment of fungal infections? Adverse events and clinical outcomes.

    Science.gov (United States)

    Garbino, Jorge; Markham, Lydia; Matulionyte, Raimonda; Rives, Vincent; Lew, Daniel

    2006-01-01

    Amphotericin B deoxycholate (AmBd) has been a standard therapy for IFI but is associated with high adverse event and mortality rates. A retrospective review was undertaken to describe adverse events and clinical outcomes in adult patients with IFI treated with only AmBd as initial therapy. PMID:16449001

  18. The adverse effect of spasticity on 3-month poststroke outcome using a population-based model.

    Science.gov (United States)

    Belagaje, S R; Lindsell, C; Moomaw, C J; Alwell, K; Flaherty, M L; Woo, D; Dunning, K; Khatri, P; Adeoye, O; Kleindorfer, D; Broderick, J; Kissela, B

    2014-01-01

    Several devices and medications have been used to address poststroke spasticity. Yet, spasticity's impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regression model for predicting 3-month modified Rankin Score (mRS) as an indicator of functional outcome. Here, we tested whether including spasticity improved model fit and estimated the effect spasticity had on the outcome. Spasticity was defined by a positive response to the question "Did you have spasticity following your stroke?" on direct interview at 3 months from stroke onset. Patients who had expired by 90 days (n = 30) or did not have spasticity data available (n = 102) were excluded. Spasticity affected the 3-month functional status (β = 0.420, 95 CI = 0.194 to 0.645) after accounting for age, diabetes, leukoaraiosis, and retrospective NIHSS. Using spasticity as a covariable, the model's R (2) changed from 0.599 to 0.622. In our model, the presence of spasticity in the cohort was associated with a worsened 3-month mRS by an average of 0.4 after adjusting for known covariables. This significant adverse effect on functional outcomes adds predictive value beyond previously established factors. PMID:25147752

  19. The Adverse Effect of Spasticity on 3-Month Poststroke Outcome Using a Population-Based Model

    Directory of Open Access Journals (Sweden)

    S. R. Belagaje

    2014-01-01

    Full Text Available Several devices and medications have been used to address poststroke spasticity. Yet, spasticity’s impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regression model for predicting 3-month modified Rankin Score (mRS as an indicator of functional outcome. Here, we tested whether including spasticity improved model fit and estimated the effect spasticity had on the outcome. Spasticity was defined by a positive response to the question “Did you have spasticity following your stroke?” on direct interview at 3 months from stroke onset. Patients who had expired by 90 days (n=30 or did not have spasticity data available (n=102 were excluded. Spasticity affected the 3-month functional status (β=0.420, 95 CI=0.194 to 0.645 after accounting for age, diabetes, leukoaraiosis, and retrospective NIHSS. Using spasticity as a covariable, the model’s R2 changed from 0.599 to 0.622. In our model, the presence of spasticity in the cohort was associated with a worsened 3-month mRS by an average of 0.4 after adjusting for known covariables. This significant adverse effect on functional outcomes adds predictive value beyond previously established factors.

  20. Prevention, management and extent of adverse pregnancy outcomes in women with hereditary antithrombin deficiency.

    Science.gov (United States)

    Rogenhofer, Nina; Bohlmann, Michael K; Beuter-Winkler, Petra; Würfel, Wolfgang; Rank, Andreas; Thaler, Christian J; Toth, Bettina

    2014-03-01

    Antithrombin (AT) deficiency is a rare hereditary thrombophilia with a mean prevalence of 0.02 % in the general population, associated with a more than ten-fold increased risk of venous thromboembolism (VTE). Within this multicenter retrospective clinical analysis, female patients with inherited AT deficiency were evaluated concerning the type of inheritance and extent of AT deficiency, medical treatment during pregnancy and postpartally, VTE risk as well as maternal and neonatal outcome. Statistical analysis was performed with SPPS for Windows (19.0). A total of 18 pregnancies in 7 patients were evaluated, including 11 healthy newborns ≥37th gestational weeks (gw), one small for gestational age premature infant (25th gw), two late-pregnancy losses (21st and 28th gw) and four early miscarriages. Despite low molecular weight heparin (LMWH) administration, three VTE occurred during pregnancy and one postpartally. Several adverse pregnancy outcomes occurred including fetal and neonatal death, as well as severe maternal neurologic disorders occurred. Patients with substitution of AT during pregnancy in addition to LMWH showed the best maternal and neonatal outcome. Close monitoring with appropriate anticoagulant treatment including surveillance of AT levels might help to optimize maternal and fetal outcome in patients with hereditary AT deficiency.

  1. Laparoscopic donor nephrectomy for the pediatric recipient population: Risk factors for adverse outcomes.

    Science.gov (United States)

    Walther, Ashley E; Coots, Abigail C; Goebel, Jens W; Alonso, Maria H; Ryckman, Frederick C; Tiao, Greg M; Nathan, Jaimie D

    2015-12-01

    Kidney transplantation is the optimal treatment of ESRD in children. Some studies have reported inferior outcomes in recipients of LDN allografts who are ≤ 5 yr of age. We performed a retrospective review of pediatric recipient outcomes of 110 LDN allografts at our institution and examined predictors of adverse outcomes. Subgroup analysis was performed by dividing recipients into three age categories: 0-5 yr, 6-17 yr, and ≥ 18 yr. There was no significant difference between incidences of DGF or ARE between groups. Kaplan-Meier analysis demonstrated 100% allograft survival in 0- to 5-yr-old recipients, nearly reaching statistical significance (p = 0.07) for outcome superior to that of the two older age groups. Pretransplant HD was associated with increased risk of DGF (p = 0.05). Significant risk factors for ARE were recipient weight >15 kg (p = 0.033) and multiple renal arteries (p = 0.047). Previous ARE was associated with an increased risk of allograft failure (p = 0.02). LDN is not associated with increased risk of DGF, ARE, or allograft failure in the youngest recipients. These findings support an aggressive pursuit of preemptive transplantation even in the youngest pediatric allograft recipients. PMID:26329665

  2. Applying Adverse Outcome Pathways (AOPs) to support Integrated Approaches to Testing and Assessment (IATA).

    Science.gov (United States)

    Tollefsen, Knut Erik; Scholz, Stefan; Cronin, Mark T; Edwards, Stephen W; de Knecht, Joop; Crofton, Kevin; Garcia-Reyero, Natalia; Hartung, Thomas; Worth, Andrew; Patlewicz, Grace

    2014-12-01

    Chemical regulation is challenged by the large number of chemicals requiring assessment for potential human health and environmental impacts. Current approaches are too resource intensive in terms of time, money and animal use to evaluate all chemicals under development or already on the market. The need for timely and robust decision making demands that regulatory toxicity testing becomes more cost-effective and efficient. One way to realize this goal is by being more strategic in directing testing resources; focusing on chemicals of highest concern, limiting testing to the most probable hazards, or targeting the most vulnerable species. Hypothesis driven Integrated Approaches to Testing and Assessment (IATA) have been proposed as practical solutions to such strategic testing. In parallel, the development of the Adverse Outcome Pathway (AOP) framework, which provides information on the causal links between a molecular initiating event (MIE), intermediate key events (KEs) and an adverse outcome (AO) of regulatory concern, offers the biological context to facilitate development of IATA for regulatory decision making. This manuscript summarizes discussions at the Workshop entitled "Advancing AOPs for Integrated Toxicology and Regulatory Applications" with particular focus on the role AOPs play in informing the development of IATA for different regulatory purposes. PMID:25261300

  3. Defining molecular initiating events in the adverse outcome pathway framework for risk assessment.

    Science.gov (United States)

    Allen, Timothy E H; Goodman, Jonathan M; Gutsell, Steve; Russell, Paul J

    2014-12-15

    Consumer and environmental safety decisions are based on exposure and hazard data, interpreted using risk assessment approaches. The adverse outcome pathway (AOP) conceptual framework has been presented as a logical sequence of events or processes within biological systems which can be used to understand adverse effects and refine current risk assessment practices in ecotoxicology. This framework can also be applied to human toxicology and is explored on the basis of investigating the molecular initiating events (MIEs) of compounds. The precise definition of the MIE has yet to reach general acceptance. In this work we present a unified MIE definition: an MIE is the initial interaction between a molecule and a biomolecule or biosystem that can be causally linked to an outcome via a pathway. Case studies are presented, and issues with current definitions are addressed. With the development of a unified MIE definition, the field can look toward defining, classifying, and characterizing more MIEs and using knowledge of the chemistry of these processes to aid AOP research and toxicity risk assessment. We also present the role of MIE research in the development of in vitro and in silico toxicology and suggest how, by using a combination of biological and chemical approaches, MIEs can be identified and characterized despite a lack of detailed reports, even for some of the most studied molecules in toxicology.

  4. In Utero Exposure to Compounds with Dioxin-like Activity and Birth Outcomes

    DEFF Research Database (Denmark)

    Vafeiadi, Marina; Agramunt, Silvia; Pedersen, Marie;

    2014-01-01

    BACKGROUND: Maternal exposure to dioxins and dioxin-like compounds may affect fetal growth and development. We evaluated the association between in utero dioxin-like activity and birth outcomes in a prospective European mother-child study. METHODS: We measured dioxin-like activity in maternal...... weight, gestational age, and head circumference. RESULTS: Plasma dioxin-like activity was higher in maternal sample than in cord samples. Birth weight was lower with medium (-58 g [95% confidence interval (CI) = -176 to 62]) and high (-82 g [-216 to 53]) tertiles of exposure (cord blood) compared...... with the lowest tertile. Gestational age was shorter by approximately half a week in the highest compared with the lowest (-0.4 weeks [95% CI = -0.8 to -0.1]). This association was stronger in boys than in girls, although the statistical evidence for interaction was weak (P = 0.22). Analysis based on CALUX...

  5. Adverse Reproductive and Developmental Health Outcomes Following Prenatal Exposure to a Hydraulic Fracturing Chemical Mixture in Female C57Bl/6 Mice.

    Science.gov (United States)

    Kassotis, Christopher D; Bromfield, John J; Klemp, Kara C; Meng, Chun-Xia; Wolfe, Andrew; Zoeller, R Thomas; Balise, Victoria D; Isiguzo, Chiamaka J; Tillitt, Donald E; Nagel, Susan C

    2016-09-01

    Unconventional oil and gas operations using hydraulic fracturing can contaminate surface and groundwater with endocrine-disrupting chemicals. We have previously shown that 23 of 24 commonly used hydraulic fracturing chemicals can activate or inhibit the estrogen, androgen, glucocorticoid, progesterone, and/or thyroid receptors in a human endometrial cancer cell reporter gene assay and that mixtures can behave synergistically, additively, or antagonistically on these receptors. In the current study, pregnant female C57Bl/6 dams were exposed to a mixture of 23 commonly used unconventional oil and gas chemicals at approximately 3, 30, 300, and 3000 μg/kg·d, flutamide at 50 mg/kg·d, or a 0.2% ethanol control vehicle via their drinking water from gestational day 11 through birth. This prenatal exposure to oil and gas operation chemicals suppressed pituitary hormone concentrations across experimental groups (prolactin, LH, FSH, and others), increased body weights, altered uterine and ovary weights, increased heart weights and collagen deposition, disrupted folliculogenesis, and other adverse health effects. This work suggests potential adverse developmental and reproductive health outcomes in humans and animals exposed to these oil and gas operation chemicals, with adverse outcomes observed even in the lowest dose group tested, equivalent to concentrations reported in drinking water sources. These endpoints suggest potential impacts on fertility, as previously observed in the male siblings, which require careful assessment in future studies. PMID:27560547

  6. Cord blood vitamin D status and neonatal outcomes in a birth cohort in Quebec, Canada

    Science.gov (United States)

    Morgan, Catherine; Dodds, Linda; Langille, Donald B.; Weiler, Hope A.; Armson, B. Anthony; Forest, Jean-Claude; Giguère, Yves

    2016-01-01

    Purpose Some evidence suggests that low maternal vitamin D status adversely affects perinatal health but few studies have examined cord blood vitamin D status. This project aimed to determine the association between the cord blood concentration of 25-hydroxyvitamin D [25(OH)D] and neonatal outcomes. Methods A nested case–control study was conducted in Quebec City, Canada from 2005 to 2010. Included were 83 cases of low birthweight (LBW; literature that considers the full spectrum of maternal and neonatal outcomes. PMID:26404451

  7. Correlation of Clinical and Dosimetric Factors With Adverse Pulmonary Outcomes in Children After Lung Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Venkatramani, Rajkumar, E-mail: rvenkatramani@chla.usc.edu [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Kamath, Sunil [Department of Pulmonology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Wong, Kenneth [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Olch, Arthur J. [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Radiation Oncology, University of Southern California, Los Angeles, California (United States); Malvar, Jemily [Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Sposto, Richard [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Goodarzian, Fariba [Department of Radiology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Freyer, David R. [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Keens, Thomas G. [Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Department of Pulmonology, Children' s Hospital Los Angeles, Los Angeles, California (United States); and others

    2013-08-01

    Purpose: To identify the incidence and the risk factors for pulmonary toxicity in children treated for cancer with contemporary lung irradiation. Methods and Materials: We analyzed clinical features, radiographic findings, pulmonary function tests, and dosimetric parameters of children receiving irradiation to the lung fields over a 10-year period. Results: We identified 109 patients (75 male patients). The median age at irradiation was 13.8 years (range, 0.04-20.9 years). The median follow-up period was 3.4 years. The median prescribed radiation dose was 21 Gy (range, 0.4-64.8 Gy). Pulmonary toxic chemotherapy included bleomycin in 58.7% of patients and cyclophosphamide in 83.5%. The following pulmonary outcomes were identified and the 5-year cumulative incidence after irradiation was determined: pneumonitis, 6%; chronic cough, 10%; pneumonia, 35%; dyspnea, 11%; supplemental oxygen requirement, 2%; radiographic interstitial lung disease, 40%; and chest wall deformity, 12%. One patient died of progressive respiratory failure. Post-irradiation pulmonary function tests available from 44 patients showed evidence of obstructive lung disease (25%), restrictive disease (11%), hyperinflation (32%), and abnormal diffusion capacity (12%). Thoracic surgery, bleomycin, age, mean lung irradiation dose (MLD), maximum lung dose, prescribed dose, and dosimetric parameters between V{sub 22} (volume of lung exposed to a radiation dose ≥22 Gy) and V{sub 30} (volume of lung exposed to a radiation dose ≥30 Gy) were significant for the development of adverse pulmonary outcomes on univariate analysis. MLD, maximum lung dose, and V{sub dose} (percentage of volume of lung receiving the threshold dose or greater) were highly correlated. On multivariate analysis, MLD was the sole significant predictor of adverse pulmonary outcome (P=.01). Conclusions: Significant pulmonary dysfunction occurs in children receiving lung irradiation by contemporary techniques. MLD rather than prescribed

  8. Integrating Publicly Available Data to Generate Computationally Predicted Adverse Outcome Pathways for Fatty Liver.

    Science.gov (United States)

    Bell, Shannon M; Angrish, Michelle M; Wood, Charles E; Edwards, Stephen W

    2016-04-01

    Newin vitrotesting strategies make it possible to design testing batteries for large numbers of environmental chemicals. Full utilization of the results requires knowledge of the underlying biological networks and the adverse outcome pathways (AOPs) that describe the route from early molecular perturbations to an adverse outcome. Curation of a formal AOP is a time-intensive process and a rate-limiting step to designing these test batteries. Here, we describe a method for integrating publicly available data in order to generate computationally predicted AOP (cpAOP) scaffolds, which can be leveraged by domain experts to shorten the time for formal AOP development. A network-based workflow was used to facilitate the integration of multiple data types to generate cpAOPs. Edges between graph entities were identified through direct experimental or literature information, or computationally inferred using frequent itemset mining. Data from the TG-GATEs and ToxCast programs were used to channel large-scale toxicogenomics information into a cpAOP network (cpAOPnet) of over 20 000 relationships describing connections between chemical treatments, phenotypes, and perturbed pathways as measured by differential gene expression and high-throughput screening targets. The resulting fatty liver cpAOPnet is available as a resource to the community. Subnetworks of cpAOPs for a reference chemical (carbon tetrachloride, CCl4) and outcome (fatty liver) were compared with published mechanistic descriptions. In both cases, the computational approaches approximated the manually curated AOPs. The cpAOPnet can be used for accelerating expert-curated AOP development and to identify pathway targets that lack genomic markers or high-throughput screening tests. It can also facilitate identification of key events for designing test batteries and for classification and grouping of chemicals for follow up testing.

  9. Correlation of Clinical and Dosimetric Factors With Adverse Pulmonary Outcomes in Children After Lung Irradiation

    International Nuclear Information System (INIS)

    Purpose: To identify the incidence and the risk factors for pulmonary toxicity in children treated for cancer with contemporary lung irradiation. Methods and Materials: We analyzed clinical features, radiographic findings, pulmonary function tests, and dosimetric parameters of children receiving irradiation to the lung fields over a 10-year period. Results: We identified 109 patients (75 male patients). The median age at irradiation was 13.8 years (range, 0.04-20.9 years). The median follow-up period was 3.4 years. The median prescribed radiation dose was 21 Gy (range, 0.4-64.8 Gy). Pulmonary toxic chemotherapy included bleomycin in 58.7% of patients and cyclophosphamide in 83.5%. The following pulmonary outcomes were identified and the 5-year cumulative incidence after irradiation was determined: pneumonitis, 6%; chronic cough, 10%; pneumonia, 35%; dyspnea, 11%; supplemental oxygen requirement, 2%; radiographic interstitial lung disease, 40%; and chest wall deformity, 12%. One patient died of progressive respiratory failure. Post-irradiation pulmonary function tests available from 44 patients showed evidence of obstructive lung disease (25%), restrictive disease (11%), hyperinflation (32%), and abnormal diffusion capacity (12%). Thoracic surgery, bleomycin, age, mean lung irradiation dose (MLD), maximum lung dose, prescribed dose, and dosimetric parameters between V22 (volume of lung exposed to a radiation dose ≥22 Gy) and V30 (volume of lung exposed to a radiation dose ≥30 Gy) were significant for the development of adverse pulmonary outcomes on univariate analysis. MLD, maximum lung dose, and Vdose (percentage of volume of lung receiving the threshold dose or greater) were highly correlated. On multivariate analysis, MLD was the sole significant predictor of adverse pulmonary outcome (P=.01). Conclusions: Significant pulmonary dysfunction occurs in children receiving lung irradiation by contemporary techniques. MLD rather than prescribed dose should be used

  10. Maternal arsenic exposure and DNA damage biomarkers, and the associations with birth outcomes in a general population from Taiwan.

    Directory of Open Access Journals (Sweden)

    Wei-Chun Chou

    Full Text Available Inorganic arsenic (iAs is an established transplacental agent known to affect fetal development in animal studies. However, iAs has not been adequately studied in the general population with respect to iAs exposure during pregnancy and its impact on the health status of newborns. The aims of this study were to 1 elucidate the association between arsenic exposure and oxidative/methylated DNA damage in pregnant women, and 2 determine the association with birth outcomes. A birth cohort study of 299 pregnant mother-newborn pairs was recruited during 2001-2002 in Taiwan. We collected maternal urine samples during the 3(rd trimester for measuring iAs and its metabolites. We used high-performance liquid chromatography/inductively coupled plasma mass spectrometry (HPLC-ICP-MS for quantifications of the arsenic species. Liquid chromatography/tandem mass spectrometer (LC-MS/MS was used to measure the 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG and N(7-methylguanosine (N(7-MeG DNA damage biomarkers. Birth outcomes were collected to assess the associations with maternal arsenic exposure and the DNA damage biomarkers. Multiple regression analyses showed that maternal urinary iAs had positive associations with the methylated N(7-MeG (beta = 0.35, p<0.001 and oxidative 8-oxodG (beta = 0.24, p<0.001 DNA damage biomarkers, and a decreased one-minute (1-min Apgar score (beta = -0.23, p = 0.041. Maternal N(7-MeG was also associated with a decreased 1-min Apgar score (beta = -0.25, p = 0.042. Mutual adjustment for iAs and N(7-MeG showed an independent and significant prediction for a decreased 1-min Apgar score of iAs (beta = -0.28, p = 0.036. Maternal iAs exposure was associated with both maternal DNA damage and adverse newborn health. Maternal N(7-MeG levels might be a novel biomarker for monitoring fetal health related to iAs.

  11. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia

    Directory of Open Access Journals (Sweden)

    Senturk MB

    2015-07-01

    Full Text Available Mehmet Baki Senturk,1 Yusuf Cakmak,2 Halit Atac,2 Mehmet Sukru Budak3 1Department of Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey; 2Department of Obstetrics and Gynecology, Batman State Hospital, Batman, Turkey; 3Department of Obstetrics and Gynecology, Diyarbakir Research Hospital, Diyarbakir, Turkey Abstract: Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P<0.01, but these were minor. The rate of blood transfusion and prevalence of changes in hemoglobin level were similar in both groups (P>0.05. In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients’ requests influenced outcome. Trial of

  12. Increased traffic exposure and negative birth outcomes: a prospective cohort in Australia

    OpenAIRE

    Wilson Lee-Ann; Seow W Kim; Plonka Kathryn; Barnett Adrian G; Hansen Craig

    2011-01-01

    Abstract Background Pregnant women exposed to traffic pollution have an increased risk of negative birth outcomes. We aimed to investigate the size of this risk using a prospective cohort of 970 mothers and newborns in Logan, Queensland. Methods We examined two measures of traffic: distance to nearest road and number of roads around the home. To examine the effect of distance we used the number of roads around the home in radii from 50 to 500 metres. We examined three road types: freeways, hi...

  13. The risk of adverse pregnancy outcomes in women who are overweight or obese

    Directory of Open Access Journals (Sweden)

    Willson Kristyn J

    2010-09-01

    Full Text Available Abstract Background The prevalence of obesity amongst women bearing children in Australia is rising and has important implications for obstetric care. The aim of this study was to assess the prevalence and impact of mothers being overweight and obese in early to mid-pregnancy on maternal, peripartum and neonatal outcomes. Methods A secondary analysis was performed on data collected from nulliparous women with a singleton pregnancy enrolled in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia (ACTS. Women were categorized into three groups according to their body mass index (BMI: normal (BMI 18.5-24.9 kg/m2; overweight (BMI 25-29.9 kg/m2 and; obese (BMI 30-34.9 kg/m2. Obstetric and perinatal outcomes were compared by univariate and multivariate analyses. Results Of the 1661 women included, 43% were overweight or obese. Obese women were at increased risk of pre-eclampsia (relative risk (RR 2.99 [95% confidence intervals (CI 1.88, 4.73], p Conclusion The rate of overweight and obesity is increasing amongst the Australian obstetric population. Women who are overweight and obese have an increased risk of adverse pregnancy outcomes. In particular, obese women are at increased risk of gestational diabetes, pregnancy induced hypertension and pre-eclampsia. Effective preventative strategies are urgently needed. Trial Registration Current Controlled Trials ISRCTN00416244

  14. Integrated approaches to improve birth outcomes: perinatal periods of risk, infant mortality review, and the Los Angeles Mommy and Baby Project.

    Science.gov (United States)

    Chao, Shin Margaret; Donatoni, Giannina; Bemis, Cathleen; Donovan, Kevin; Harding, Cynthia; Davenport, Deborah; Gilbert, Carol; Kasehagen, Laurin; Peck, Magda G

    2010-11-01

    This article provides an example of how Perinatal Periods of Risk (PPOR) can provide a framework and offer analytic methods that move communities to productive action to address infant mortality. Between 1999 and 2002, the infant mortality rate in the Antelope Valley region of Los Angeles County increased from 5.0 to 10.6 per 1,000 live births. Of particular concern, infant mortality among African Americans in the Antelope Valley rose from 11.0 per 1,000 live births (7 cases) in 1999 to 32.7 per 1,000 live births (27 cases) in 2002. In response, the Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs partnered with a community task force to develop an action plan to address the issue. Three stages of the PPOR approach were used: (1) Assuring Readiness; (2) Data and Assessment, which included: (a) Using 2002 vital records to identify areas with the highest excess rates of feto-infant mortality (Phase 1 PPOR), and (b) Implementing Infant Mortality Review (IMR) and the Los Angeles Mommy and Baby (LAMB) Project, a population-based study to identify potential factors associated with adverse birth outcomes. (Phase 2 PPOR); and (3) Strategy and Planning, to develop strategic actions for targeted prevention. A description of stakeholders' commitments to improve birth outcomes and monitor infant mortality is also given. The Antelope Valley community was engaged and ready to investigate the local rise in infant mortality. Phase 1 PPOR analysis identified Maternal Health/Prematurity and Infant Health as the most important periods of risk for further investigation and potential intervention. During the Phase 2 PPOR analyses, IMR found a significant proportion of mothers with previous fetal loss (45%) or low birth weight/preterm (LBW/PT) birth, late prenatal care (39%), maternal infections (47%), and infant safety issues (21%). After adjusting for potential confounders (maternal age, race, education level, and marital status), the

  15. Early Predictors of Neurodevelopmental Adverse Outcome in Term Infants with Postasphyxial Hypoxic Ischemic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Khaled Abdulqawi

    2011-11-01

    Full Text Available Background: Neonatal brain injury due to intrapartum asphyxia is an important cause of cerebral palsy, mental retardation, and epilepsy. In developing countries, the incidence of post asphyxial neurological damage is particularly high. Despite advances in perinatal care over the past three decades, the incidence of cerebral palsy attributed to birth asphyxia has not changed.Objectives: To predict the outcome of postasphyxial hypoxic ischemic encephalopathy early in the neonatal period, for proper counseling of the parents, to get benefit in clinical practice and to select patients who will benefit from recent management strategies.Study Design: This study was conducted on 63 asphyxiated full term newborn infants who developed Hypoxic-Ischemic Encephalopathy (HIE admitted at Neonatal Intensive Care Unit of Al-Jedaany Hospital, Jeddah, Kingdom Saudi Arabia in the period from May 2006 to January 2008. They were classified according to Sarnat and Sarrnat staging of HIE into the following: 16 with stage I, HIE (Group I, 19 with stage II, HIE (Group II and 20 with stage III, HIE (Group III. Twenty full term healthy newborn infants, age and weight-matched, were served as a control. All infants were subjected to the following tests: cord blood gases at birth, and Urine sample for testing urinary lactate / creatinine ratio. Also a real-time cranial ultrasonography was done for infants who had HIE. Follow up of the cases was done by the followings: A neurodevelopmental clinical evaluation every three months till the age of one year of life was done for the cases and control infants. An Electroencephalogram (EEG and auditory brainstem evoked response (ABR were done at the age of three months and a second ABR at the age of six months for cases with abnormal previous ABR. Results: Group III (stage III, HIE has significantly increased initial, maximum and day 7 HIE scores (16.4 ± 3.1, 18.15 ± 2.79 and 13 ± 5.79 respectively compared with group I&II. Also

  16. Increased traffic exposure and negative birth outcomes: a prospective cohort in Australia

    Directory of Open Access Journals (Sweden)

    Wilson Lee-Ann

    2011-04-01

    Full Text Available Abstract Background Pregnant women exposed to traffic pollution have an increased risk of negative birth outcomes. We aimed to investigate the size of this risk using a prospective cohort of 970 mothers and newborns in Logan, Queensland. Methods We examined two measures of traffic: distance to nearest road and number of roads around the home. To examine the effect of distance we used the number of roads around the home in radii from 50 to 500 metres. We examined three road types: freeways, highways and main roads. Results There were no associations with distance to road. A greater number of freeways and main roads around the home were associated with a shorter gestation time. There were no negative impacts on birth weight, birth length or head circumference after adjusting for gestation. The negative effects on gestation were largely due to main roads within 400 metres of the home. For every 10 extra main roads within 400 metres of the home, gestation time was reduced by 1.1% (95% CI: -1.7, -0.5; p-value = 0.001. Conclusions Our results add weight to the association between exposure to traffic and reduced gestation time. This effect may be due to the chemical toxins in traffic pollutants, or because of disturbed sleep due to traffic noise.

  17. Ethno-Specific Risk Factors for Adverse Pregnancy Outcomes: Findings from the Born in Bradford Cohort Study.

    Science.gov (United States)

    Stacey, Tomasina; Prady, Stephanie; Haith-Cooper, Melanie; Downe, Soo; Simpson, Nigel; Pickett, Kate

    2016-07-01

    Objectives Preterm birth (PTB) and small for gestational age (SGA) are major causes of perinatal mortality and morbidity. Previous studies indicated a range of risk factors associated with these poor outcomes, including maternal psychosocial and economic wellbeing. This paper will explore a range of psycho-social and economic factors in an ethnically diverse population. Methods The UK's Born in Bradford cohort study recruited pregnant women attending a routine antenatal appointment at 26-28 weeks' gestation at the Bradford Royal Infirmary (2007-2010). This analysis includes 9680 women with singleton live births who completed the baseline questionnaire. Data regarding maternal socio-demographic and mental health were recorded. Outcome data were collected prospectively, and analysed using multivariate regression models. The primary outcomes measured were: PTB (order to develop appropriate targeted preventative strategies to improve perinatal outcome in disadvantaged groups, a greater understanding of ethno-specific risk factors is required. PMID:26983444

  18. The proform of eosinophil major basic protein: a new maternal serum marker for adverse pregnancy outcome

    DEFF Research Database (Denmark)

    Pihl, Kasper; Larsen, Torben; Rasmussen, Steen;

    2009-01-01

    MBP median was significantly reduced in pregnancies with SGA (0.81 MoM), spontaneous preterm delivery (0.83 MoM), preeclampsia (0.88 MoM) and gestational hypertension (0.60 MoM). The best screening performance was found for preeclampsia including the covariates proMBP and nulliparity yielding an area under......OBJECTIVE: To establish the first trimester serum levels of the proform of eosinophil major basic protein (proMBP) in pregnancies with adverse outcome. Furthermore, to determine the screening performance using proMBP alone and in combination with other first trimester markers. METHODS: A case......-control study was conducted in a primary hospital setting. The proMBP concentration was measured in cases with small-for-gestational age (SGA) (n = 150), spontaneous preterm delivery (n = 88), preeclampsia (n = 40), gestational hypertension (n = 10) and in controls (n = 500). Concentrations were converted...

  19. Malnutrition in Hospitalized Pediatric Patients: Assessment, Prevalence, and Association to Adverse Outcomes.

    Science.gov (United States)

    Daskalou, Efstratia; Galli-Tsinopoulou, Assimina; Karagiozoglou-Lampoudi, Thomais; Augoustides-Savvopoulou, Persefone

    2016-01-01

    Malnutrition is a frequent finding in pediatric health care settings in the form of undernutrition or excess body weight. Its increasing prevalence and impact on overall health status, which is reflected in the adverse outcomes, renders imperative the application of commonly accepted and evidence-based practices and tools by health care providers. Nutrition risk screening on admission and nutrition status evaluation are key points during clinical management of hospitalized pediatric patients, in order to prevent health deterioration that can lead to serious complications and growth consequences. In addition, anthropometric data based on commonly accepted universal growth standards can give accurate results for nutrition status. Both nutrition risk screening and nutrition status assessment are techniques that should be routinely implemented, based on commonly accepted growth standards and methodology, and linked to clinical outcomes. The aim of the present review was to address the issue of hospital malnutrition in pediatric settings in terms of prevalence, outline nutrition status evaluation and nutrition screening process using different criteria and available tools, and present its relationship with outcome measures. Key teaching points • Malnutrition-underweight or excess body weight-is a frequent imbalance in pediatric settings that affects physical growth and results in undesirable clinical outcomes. • Anthropometry interpretation through growth charts and nutrition screening are cornerstones for the assessment of malnutrition.To date no commonly accepted anthropometric criteria or nutrition screening tools are used in hospitalized pediatric patients. • Commonly accepted nutrition status and screening processes based on the World Health Organization's growth standards can contribute to the overall hospital nutrition care of pediatric patients. PMID:26709552

  20. Adverse events and outcomes of procedural sedation and analgesia in major trauma patients

    Directory of Open Access Journals (Sweden)

    Robert S Green

    2015-01-01

    Full Text Available Context: Trauma patients requiring procedural sedation and analgesia (PSA may have increased risk of adverse events (AEs and poor outcomes. Aims: To determine the incidence of AEs in adult major trauma patients who received PSA and to evaluate their postprocedural outcomes. Settings and Design: Retrospective analysis of adult patients (age >16 who received PSA between 2006 and 2014 at a Canadian academic tertiary care center. Materials and Methods: We compared the incidence of PSA-related AEs in trauma patients with nontrauma patients. Postprocedural outcomes including Intensive Care Unit admission, length of hospital stay, and mortality were compared between trauma patients who did or did not receive PSA. Statistical Analysis Used: Descriptive statistics and multivariable logistic regression. Results: Overall, 4324 patients received PSA during their procedure, of which 101 were trauma patients (107 procedures. The majority (77% of these 101 trauma patients were male, relatively healthy (78% with American Society of Anesthesiologists Physical Status [ASA-PS] 1, and most (85% of the 107 procedures were orthopedic manipulations. PSA-related AEs were experienced by 45.5% of the trauma group and 45.9% of the nontrauma group. In the trauma group, the most common AEs were tachypnea (23% and hypotension (20%. After controlling for age, gender, and ASA-PS, trauma patients were more likely than nontrauma patients to develop hypotension (odds ratio 1.79; 95% confidence interval 1.11-2.89. Conclusion: Although trauma patients were more likely than nontrauma patients to develop hypotension during PSA, their outcomes were not worse compared to trauma patients who did not have PSA.

  1. An integrative data mining approach to identifying adverse outcome pathway signatures.

    Science.gov (United States)

    Oki, Noffisat O; Edwards, Stephen W

    2016-03-28

    The Adverse Outcome Pathway (AOP) framework is a tool for making biological connections and summarizing key information across different levels of biological organization to connect biological perturbations at the molecular level to adverse outcomes for an individual or population. Computational approaches to explore and determine these connections can accelerate the assembly of AOPs. By leveraging the wealth of publicly available data covering chemical effects on biological systems, computationally-predicted AOPs (cpAOPs) were assembled via data mining of high-throughput screening (HTS) in vitro data, in vivo data and other disease phenotype information. Frequent Itemset Mining (FIM) was used to find associations between the gene targets of ToxCast HTS assays and disease data from Comparative Toxicogenomics Database (CTD) by using the chemicals as the common aggregators between datasets. The method was also used to map gene expression data to disease data from CTD. A cpAOP network was defined by considering genes and diseases as nodes and FIM associations as edges. This network contained 18,283 gene to disease associations for the ToxCast data and 110,253 for CTD gene expression. Two case studies show the value of the cpAOP network by extracting subnetworks focused either on fatty liver disease or the Aryl Hydrocarbon Receptor (AHR). The subnetwork surrounding fatty liver disease included many genes known to play a role in this disease. When querying the cpAOP network with the AHR gene, an interesting subnetwork including glaucoma was identified. While substantial literature exists to support the potential for AHR ligands to elicit glaucoma, it was not explicitly captured in the public annotation information in CTD. The subnetwork from this analysis suggests a cpAOP that includes changes in CYP1B1 expression, which has been previously established in the literature as a primary cause of glaucoma. These case studies highlight the value in integrating multiple data

  2. Mechanistic study of chlordecone-induced endocrine disruption: Based on an adverse outcome pathway network.

    Science.gov (United States)

    Yang, Lihua; Zhou, Bingsheng; Zha, Jinmiao; Wang, Zijian

    2016-10-01

    The adverse outcome pathway (AOP) framework could be helpful for chemical risk assessment and mechanistic research. The aim of the present study was to unravel the mechanism of chlordecone-induced endocrine disruption by illustrating the main molecular initiating event (MIE)/perturbations responsible for the observed effects. In silico simulations were performed to predict the MIE(s), and the results pointed to agonistic interaction with estrogen receptors (ERα, ERβ), androgen receptor (AR), cytochrome P450 (CYP19A) by chlordecone. In vivo endocrine disruptions were evaluated in rare minnow (Gobiocypris rarus) exposed to 0.01, 0.1, 1 and 10 μg L(-1) chlordecone from 2 h post-fertilization until sexually mature. In the females, increases of vitellogenin (vtg) mRNA levels in liver and gonad, plasma estradiol (E2), testosterone (T) and E2/T, and renalsomatic index confirmed the role of agonism of ER and CYP19A as MIEs, but the decreased gonadosomatic index, degenerated ovaries as well as the feed-forward response pointed to other potential but important MIEs and corresponding AOPs. In the males, increased E2/T ratio, increased testis vtg mRNA levels and occurrence of intersex confirmed the roles of agonism of ERα and CYP19A as main MIEs in chlordecone-induced endocrine disruptions. Our results also fetches out the limit of AOPs in predicting the adverse outcomes and explaining the mechanism of chemicals at present, thus reflected a critical need for expanding AOPs and AOP network before using it in chemical risk assessment. PMID:27448318

  3. Patient-reported outcomes and the evolution of adverse event reporting in oncology.

    Science.gov (United States)

    Trotti, Andy; Colevas, A Dimitrios; Setser, Ann; Basch, Ethan

    2007-11-10

    Adverse event (AE) reporting in oncology has evolved from informal descriptions to a highly systematized process. The Common Terminology Criteria for Adverse Events (CTCAE) is the predominant system for describing the severity of AEs commonly encountered in oncology clinical trials. CTCAE clinical descriptors have been developed empirically during more than 30 years of use. The method of data collection is clinician based. Limitations of the CTC system include potential for incomplete reporting and limited guidance on data analysis and presentation methods. The Medical Dictionary for Regulatory Activities (MedDRA) is a comprehensive medical terminology system used for regulatory reporting and drug labeling. MedDRA does not provide for severity ranking of AEs. CTC-based data presentations are the primary method of AE data reporting used in scientific journals and oncology meetings. Patient-reported outcome instruments (PROs) cover the subjective domain of AEs. Exploratory work suggests PROs can be used with a high degree of patient engagement and compliance. Additional studies are needed to determine how PROs can be used to complement current AE reporting systems. Potential models for integrating PROs into AE reporting are described in this review. AE reporting methods will continue to evolve in response to changing therapies and growing interest in measuring the impact of cancer treatment on health status. Although integration of PROs into AE reporting may ultimately improve the comprehensiveness and quality of collected data, it may also increase the administrative burden and cost of conducting trials. Therefore, care must be used when developing health outcomes and safety data collection plans. PMID:17991931

  4. Subvalvular apparatus and adverse outcome of balloon valvotomy in rheumatic mitral stenosis☆

    Science.gov (United States)

    Bhalgat, Parag; Karlekar, Shrivallabh; Modani, Santosh; Agrawal, Ashish; Lanjewar, Charan; Nabar, Ashish; Kerkar, Prafulla; Agrawal, Nandu; Vaideeswar, Pradeep

    2015-01-01

    Background Balloon mitral valvotomy (BMV) is a well-established therapeutic modality for rheumatic mitral stenosis (RMS). However, there are chances of procedural failure and the more ominous post-procedural severe mitral regurgitation. There are only a few prospective studies, which have evaluated the pathogenic mechanisms for these major complications of BMV, especially in relation to the subvalvular apparatus (SVA) pathology. Methods All symptomatic patients of RMS suitable for BMV by echocardiographic criteria in a span of 1 year were selected. In addition to the standard echocardiographic assessment of RMS (Wilkins score and score by Padial et al.), a separate grading and scoring system was assigned to evaluate the severity of the SVA pathology. The SVA score was ‘I’, when none of the two SVAs had severe disease, ‘II’ when one of the two SVAs has severe disease, and ‘III’ when both SVAs had severe disease. With these scoring systems, the outcomes of BMV (successful procedure, failure, and post-procedural mitral regurgitation) were analyzed. Emergency valve replacement was performed depending on clinical situation, and in cases of replacement, the pathology of the excised mitral valves were compared with echocardiographic findings. Results Of the 356 BMVs performed in a year, 43 patients had adverse outcomes in the form of failed procedure (14 patients) and mitral regurgitation (29 patients). Forty-one among these had a SVA score of III. The sensitivity and specificity of the MR score was lesser than the SVA score (sensitivity 0.34 vs. 1.00, specificity 0.92 vs. 0.99, respectively). The mitral valvular morphology in 39 patients who underwent post-procedural valve replacements correlated well with echocardiography findings. Conclusion It is important to assess the degree of SVA pathology in the conventional echocardiographic assessment for RMS, as BMV would have adverse events when both SVAs were severely diseased. PMID:26432729

  5. Child Sexual Abuse and Persistence of Risky Sexual Behaviors and Negative Sexual Outcomes over Adulthood: Findings from a Birth Cohort

    Science.gov (United States)

    van Roode, Thea; Dickson, Nigel; Herbison, Peter; Paul, Charlotte

    2009-01-01

    Objectives: To determine the impact of child sexual abuse (CSA) on adult sexual behaviors and outcomes over three age periods. Methods: A longitudinal study of a birth cohort born in Dunedin, New Zealand in 1972/1973 was used. Information on CSA was sought at age 26, and on sexual behaviors and outcomes at ages 21, 26, and 32. Comparisons were…

  6. Comparison of Obstetric Outcome in Terms of the Risk of Low Birth Weight, Preterm Delivery, Cesarean Section Rate and Anemia in Primigravid Adolescents and Older Primigravida

    International Nuclear Information System (INIS)

    Objective: To compare the obstetric outcome in terms of risk of low birth weight, preterm delivery, cesarean section rate and anemia in primigravid adolescents and older primigravida. Study Design: Cohort study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore, from July to December 2012. Methodology: Three hundred primigravid women presenting to department of obstetrics and gynecology of Sir Ganga Ram Hospital, Lahore, having live singleton pregnancy, including 150 adolescents (A/sup 2/ 19 years) and 150 adults (A/sup 3/ 20 years) were studied. Obstetric outcome in terms of gestational age at delivery, infant's birth weight, presence of anemia and cesarean section rate was compared between two groups. Results were analyzed using Statistical Package for Social Sciences (SPSS) version 16. Chi-square test was applied with 0.05 as level of significance. Results: The mean age of adolescent subjects was 17.3 + 1.5 years and of adults 25.6 + 3.4 years. Mean gestational age at delivery was similar in two groups (39.2 weeks and 39.4 weeks, p = 0.37). Adolescents were more likely to have a preterm delivery (11.2% vs. 4.9%, p = 0.04) and low birth weight infants (19.3% vs. 8.2%, p = 0.005) than adults. Adolescents were more likely to be anemic (46% vs. 32%, p = 0.01) than adults. However, cesarean section rate was not statistically different between two groups. Conclusion: This study showed that primiparous adolescents have significantly higher risk of adverse pregnancy outcomes such as preterm delivery, low birth weight infants and anemia as compared to adult primiparas. (author)

  7. Developmental outcome of very low birth weight infants in a developing country

    Directory of Open Access Journals (Sweden)

    Ballot Daynia E

    2012-02-01

    Full Text Available Abstract Background Advances in neonatal care allow survival of extremely premature infants, who are at risk of handicap. Neurodevelopmental follow up of these infants is an essential part of ongoing evaluation of neonatal care. The neonatal care in resource limited developing countries is very different to that in first world settings. Follow up data from developing countries is essential; it is not appropriate to extrapolate data from units in developed countries. This study provides follow up data on a population of very low birth weight (VLBW infants in Johannesburg, South Africa. Methods The study sample included all VLBW infants born between 01/06/2006 and 28/02/2007 and discharged from the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH. Bayley Scales of Infant and Toddler Development Version 111 (BSID 111 were done to assess development. Regression analysis was done to determine factors associated with poor outcome. Results 178 infants were discharged, 26 were not available for follow up, 9 of the remaining 152 (5.9% died before an assessment was done; 106 of the remaining 143 (74.1% had a BSID 111 assessment. These 106 patients form the study sample; mean birth weight and mean gestational age was 1182 grams (SD: 197.78 and 30.81 weeks (SD: 2.67 respectively. The BSID (111 was done at a median age of 16.48 months. The mean cognitive subscale was 88.6 (95% CI: 85.69 - 91.59, 9 (8.5% were Conclusion Although the neurodevelopmental outcome of this group of VLBW infants was within the normal range, with a low incidence of cerebral palsy, these results may reflect the low survival of babies with a birth weight below 900 grams. In addition, mean subscale scores were low and one third of the babies were identified as "at risk", indicating that this group of babies warrants long-term follow up into school going age.

  8. Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy

    Energy Technology Data Exchange (ETDEWEB)

    Showalter, Timothy N., E-mail: tns3b@virginia.edu [Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia (United States); Hegarty, Sarah E. [Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Rabinowitz, Carol [Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Maio, Vittorio [Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Hyslop, Terry [Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina (United States); Dicker, Adam P. [Department of Radiation Oncology, Kimmel Cancer Center & Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Louis, Daniel Z. [Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States)

    2015-03-15

    Purpose: Although the likelihood of radiation-related adverse events influences treatment decisions regarding radiation therapy after prostatectomy for eligible patients, the data available to inform decisions are limited. This study was designed to evaluate the genitourinary, gastrointestinal, and sexual adverse events associated with postprostatectomy radiation therapy and to assess the influence of radiation timing on the risk of adverse events. Methods: The Regione Emilia-Romagna Italian Longitudinal Health Care Utilization Database was queried to identify a cohort of men who received radical prostatectomy for prostate cancer during 2003 to 2009, including patients who received postprostatectomy radiation therapy. Patients with prior radiation therapy were excluded. Outcome measures were genitourinary, gastrointestinal, and sexual adverse events after prostatectomy. Rates of adverse events were compared between the cohorts who did and did not receive postoperative radiation therapy. Multivariable Cox proportional hazards models were developed for each class of adverse events, including models with radiation therapy as a time-varying covariate. Results: A total of 9876 men were included in the analyses: 2176 (22%) who received radiation therapy and 7700 (78%) treated with prostatectomy alone. In multivariable Cox proportional hazards models, the additional exposure to radiation therapy after prostatectomy was associated with increased rates of gastrointestinal (rate ratio [RR] 1.81; 95% confidence interval [CI] 1.44-2.27; P<.001) and urinary nonincontinence events (RR 1.83; 95% CI 1.83-2.80; P<.001) but not urinary incontinence events or erectile dysfunction. The addition of the time from prostatectomy to radiation therapy interaction term was not significant for any of the adverse event outcomes (P>.1 for all outcomes). Conclusion: Radiation therapy after prostatectomy is associated with an increase in gastrointestinal and genitourinary adverse events. However

  9. Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy

    International Nuclear Information System (INIS)

    Purpose: Although the likelihood of radiation-related adverse events influences treatment decisions regarding radiation therapy after prostatectomy for eligible patients, the data available to inform decisions are limited. This study was designed to evaluate the genitourinary, gastrointestinal, and sexual adverse events associated with postprostatectomy radiation therapy and to assess the influence of radiation timing on the risk of adverse events. Methods: The Regione Emilia-Romagna Italian Longitudinal Health Care Utilization Database was queried to identify a cohort of men who received radical prostatectomy for prostate cancer during 2003 to 2009, including patients who received postprostatectomy radiation therapy. Patients with prior radiation therapy were excluded. Outcome measures were genitourinary, gastrointestinal, and sexual adverse events after prostatectomy. Rates of adverse events were compared between the cohorts who did and did not receive postoperative radiation therapy. Multivariable Cox proportional hazards models were developed for each class of adverse events, including models with radiation therapy as a time-varying covariate. Results: A total of 9876 men were included in the analyses: 2176 (22%) who received radiation therapy and 7700 (78%) treated with prostatectomy alone. In multivariable Cox proportional hazards models, the additional exposure to radiation therapy after prostatectomy was associated with increased rates of gastrointestinal (rate ratio [RR] 1.81; 95% confidence interval [CI] 1.44-2.27; P<.001) and urinary nonincontinence events (RR 1.83; 95% CI 1.83-2.80; P<.001) but not urinary incontinence events or erectile dysfunction. The addition of the time from prostatectomy to radiation therapy interaction term was not significant for any of the adverse event outcomes (P>.1 for all outcomes). Conclusion: Radiation therapy after prostatectomy is associated with an increase in gastrointestinal and genitourinary adverse events. However

  10. Paroxysmal supraventricular tachycardia in pregnant women and birth outcomes of their children: a population-based study.

    Science.gov (United States)

    Bánhidy, Ferenc; Ács, Nándor; Puhó, Erzsébet H; Czeizel, Andrew E

    2015-08-01

    The aim of the study was to estimate the possible association of pregnant women with paroxysmal supraventricular tachycardia (PSVT) with the possible risk for adverse birth outcomes, particularly different congenital abnormalities (CAs) in their children. Prospectively and medically recorded PSVT was evaluated in 103 pregnant women who later had offspring with CA (case group) and 149 pregnant women who later delivered newborn infants without CA (control group) and matched to cases in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. Of 252 pregnant women with PSVT, 115 (45.6%) had the onset of this condition before the study pregnancy, that is, their PSVT was a chronic condition, while the rest (N = 137) of PSVT was considered as new onset in the study pregnancy. The comparison of occurrence of PSVT in pregnant women who had offspring with different CA groups and in control mothers showed a higher risk for cardiovascular CAs (adjusted OR with 95% CI: 2.1, 1.1-3.8) explained mainly by secundum atrial septal defect. This association was confirmed in pregnant women with PSVT in the second and/or third gestational month, that is, critical period of cardiovascular CAs. In conclusion PSVT in pregnant women associates with a higher risk of secundum atrial septal defect in their children.

  11. Serum 25-hydroxyvitamin D levels are not associated with adverse outcomes in Clostridium difficile infection

    Directory of Open Access Journals (Sweden)

    Dejan Micic

    2015-09-01

    Full Text Available Clostridium difficile infection (CDI is a significant source of healthcare-associated morbidity and mortality. This study investigated whether serum 25-hydroxyvitamin D is associated with adverse outcomes from CDI. Patients with CDI were prospectively enrolled. Charts were reviewed and serum 25-hydroxyvitamin D was measured. The primary outcome was a composite definition of severe disease: fever (temperature >38°C, acute organ dysfunction, or serum white blood cell count >15,000 cells/μL within 24-48 hours of diagnosis; lack of response to therapy by day 5; and intensive care unit admission; colectomy; or death within 30 days. Sixty-seven patients were included in the final analysis. Mean (±SD serum 25- hydroxyvitamin D was 26.1 (±18.54 ng/mL. Severe disease, which occurred in 26 (39% participants, was not associated with serum 25-hydroxyvitamin D [odds ratio (OR 1.00; 95% confidence interval (CI 0.96-1.04]. In the adjusted model for severe disease only serum albumin (OR 0.12; 95%CI 0.02-0.64 and diagnosis by detection of stool toxin (OR 5.87; 95%CI 1.09-31.7 remained independent predictors. We conclude that serum 25-hydroxyvitamin D is not associated with the development of severe disease in patients with CDI.

  12. Exposing physicians to reduced residency work hours did not adversely affect patient outcomes after residency.

    Science.gov (United States)

    Jena, Anupam B; Schoemaker, Lena; Bhattacharya, Jay

    2014-10-01

    In 2003, work hours for physicians-in-training (residents) were capped by regulation at eighty hours per week, leading to the hotly debated but unexplored issue of whether physicians today are less well trained as a result of these work-hour reforms. Using a unique database of nearly all hospitalizations in Florida during 2000-09 that were linked to detailed information on the medical training history of the physician of record for each hospitalization, we studied whether hospital mortality and patients' length-of-stay varied according to the number of years a physician was exposed to the 2003 duty-hour regulations during his or her residency. We examined this database of practicing Florida physicians, using a difference-in-differences analysis that compared trends in outcomes of junior physicians (those with one-year post-residency experience) pre- and post-2003 to a control group of senior physicians (those with ten or more years of post-residency experience) who were not exposed to these reforms during their residency. We found that the duty-hour reforms did not adversely affect hospital mortality and length-of-stay of patients cared for by new attending physicians who were partly or fully exposed to reduced duty hours during their own residency. However, assessment of the impact of the duty-hour reforms on other clinical outcomes is needed. PMID:25288430

  13. Role of Doppler Indices in the Prediction of Adverse Perinatal Outcome in Preeclampsia

    Directory of Open Access Journals (Sweden)

    Monika Singh

    2013-08-01

    Full Text Available Objectives : To determine the role of doppler indices in the prediction of perinatal outcome in pre eclampsia. Materials and methods: A prospective study was conducted at Patna Medical College and Hospital between March 2008-March 2009 on 50 pregnant patients with preeclampsia at and #8805;32 weeks gestation .All these patients were subjected to a detailed history ,clinical examination and laboratory investigations. Study of fetal vesels was performed serially using a pulsed Doppler ultrasound ..Resistance index (RI, pulsatility index(PI and systolic / diastolic ratio (S/D were measured in middle cerebral artery (MCA and umbilical artery (UA. FL/AC(femur length/abdominal circumference ratio was also measured. Results:30 patients had IUGR(intrauterine growth restriction. The patients with abnormal indices had higher incidence of caesarean delivery(44%, low apgar score(32%, need for admission to NICU(26%and neonatal complications(24%as compared to those with normal indices. Conclusion :Doppler indices were more accurate than FL/AC ratio in the early detection of IUGR. MCA/UA ratios were more accurate than the individual components of MCA and UA.Abnormal Doppler ratios were significant predictors of IUGR and adverse perinatal outcome [Natl J Med Res 2013; 3(4.000: 315-318

  14. First trimester screening using ultrasound and serum markers in Panamanians : f0 actors associated with adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Tania T Herrera

    2014-01-01

    Full Text Available Background: There is no published data on the association between serum biochemical and ultrasonographic markers and adverse pregnancy outcomes. Therefore, the aim of this study was to determine the factors associated with perinatal outcomes in singleton pregnancies using ultrasound and maternal serum markers during the first trimester in Panamanians. Materials and Methods: This was a prospective observational study of 468 first trimester singleton pregnancies conducted over a 7-year period. All women attending a prenatal screening clinic during the study period were informed of the study and the option to participate. Two maternal serum markers, free β-human chorionic gonadotropin (β-hCG and pregnancy associated plasma protein-A (PAPP-A, and four fetal ultrasound markers, nuchal translucency thickness, nasal bone, flow across the tricuspid valve, and flow in the ductus venosus (DV, were measured by certified maternal fetal medicine specialists. Adverse outcomes included miscarriage, major structural defects, genetic disorders, and major fetal cardiac defects. Results: A total of 454 (97% pregnancies were unaffected. Median maternal age was 31.5 years (range: 18-50. Maternal age was significantly greater in cases of adverse outcome (P = 0.007. The number of adverse outcomes associated with an absent or hypoplastic nasal bone, tricuspid valve regurgitation, and abnormal flow in the DV were significantly greater relative to unaffected pregnancies (Ps < 0.001. No differences were found in fetal crown-rump length or maternal serum levels of β-hCG or PAPP-A. Conclusion: Abnormal ultrasound markers are associated with adverse outcomes. Women with normal ultrasound and serum markers should be reassured of low risk of adverse pregnancy outcomes.

  15. Maternal mortality in rural south Ethiopia: outcomes of community-based birth registration by health extension workers.

    Directory of Open Access Journals (Sweden)

    Yaliso Yaya

    Full Text Available Rural communities in low-income countries lack vital registrations to track birth outcomes. We aimed to examine the feasibility of community-based birth registration and measure maternal mortality ratio (MMR in rural south Ethiopia.In 2010, health extension workers (HEWs registered births and maternal deaths among 421,639 people in three districts (Derashe, Bonke, and Arba Minch Zuria. One nurse-supervisor per district provided administrative and technical support to HEWs. The primary outcomes were the feasibility of registration of a high proportion of births and measuring MMR. The secondary outcome was the proportion of skilled birth attendance. We validated the completeness of the registry and the MMR by conducting a house-to-house survey in 15 randomly selected villages in Bonke.We registered 10,987 births (81·4% of expected 13,492 births with annual crude birth rate of 32 per 1,000 population. The validation study showed that, of 2,401 births occurred in the surveyed households within eight months of the initiation of the registry, 71·6% (1,718 were registered with similar MMRs (474 vs. 439 between the registered and unregistered births. Overall, we recorded 53 maternal deaths; MMR was 489 per 100,000 live births and 83% (44 of 53 maternal deaths occurred at home. Ninety percent (9,863 births were at home, 4% (430 at health posts, 2·5% (282 at health centres, and 3·5% (412 in hospitals. MMR increased if: the male partners were illiterate (609 vs. 346; p= 0·051 and the villages had no road access (946 vs. 410; p= 0·039. The validation helped to increase the registration coverage by 10% through feedback discussions.It is possible to obtain a high-coverage birth registration and measure MMR in rural communities where a functional system of community health workers exists. The MMR was high in rural south Ethiopia and most births and maternal deaths occurred at home.

  16. The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review.

    Science.gov (United States)

    Kim, Daniel; Saada, Adrianna

    2013-06-01

    Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world.

  17. Association of organophosphate pesticide exposure and paraoxonase with birth outcome in Mexican-American women.

    Directory of Open Access Journals (Sweden)

    Kim G Harley

    Full Text Available BACKGROUND: Epidemiologic studies suggest that maternal organophosphorus (OP pesticide exposure is associated with poorer fetal growth, but findings are inconsistent. We explored whether paraoxonase (PON1, a key enzyme involved in detoxification of OPs, could be an effect modifier in this association. METHODS: The study population included 470 pregnant women enrolled in the CHAMACOS Study, a longitudinal cohort study of mothers and children living in an agricultural region of California. We analyzed urine samples collected from mothers twice during pregnancy for dialkyl phosphate (DAP metabolites of OP pesticides. We analyzed maternal and fetal (cord blood samples for PON1 genotype (PON1(192 and PON1(-108 and enzyme activity (paraoxonase and arylesterase. Infant birth weight, head circumference, and gestational age were obtained from medical records. RESULTS: Infants' PON1 genotype and activity were associated with birth outcome, but mothers' were not. Infants with the susceptible PON1(-108TT genotype had shorter gestational age (β = -0.5 weeks, 95% Confidence Interval (CI: -0.9, 0.0 and smaller head circumference (β = -0.4 cm, 95% CI: -0.7, 0.0 than those with the PON1(-108CC genotype. Infants' arylesterase and paraoxonase activity were positively associated with gestational age. There was some evidence of effect modification with DAPs: maternal DAP concentrations were associated with shorter gestational age only among infants of the susceptible PON1(-108TT genotype (p-value(interaction = 0.09. However, maternal DAP concentrations were associated with larger birth weight (p-value(interaction = 0.06 and head circumference (p-value(interaction<0.01 in infants with non-susceptible genotypes. CONCLUSIONS: Infants whose PON1 genotype and enzyme activity levels suggested that they might be more susceptible to the effects of OP pesticide exposure had decreased fetal growth and length of gestation. PON1 may be another factor

  18. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands.

    OpenAIRE

    Wiegers, T.A.; Keirse, M.J.N.C.; Zee, J. van der; Berghs, G.A.H.

    1996-01-01

    OBJECTIVE: To investigate the relation between the intended place of birth (home or hospital) and perinatal outcome in women with low risk pregnancies after controlling for parity and social, medical, and obstetric background. DESIGN: Analysis of prospective data from midwives and their clients. SETTING: 54 midwifery practices in the province of Gelderland, Netherlands. SUBJECTS: 97 midwives and 1836 women with low risk pregnancies who had planned to give birth at home or in hospital. MAIN OU...

  19. ECG marker of adverse electrical remodeling post-myocardial infarction predicts outcomes in MADIT II study.

    Directory of Open Access Journals (Sweden)

    Larisa G Tereshchenko

    Full Text Available BACKGROUND: Post-myocardial infarction (MI structural remodeling is characterized by left ventricular dilatation, fibrosis, and hypertrophy of the non-infarcted myocardium. OBJECTIVE: The goal of our study was to quantify post-MI electrical remodeling by measuring the sum absolute QRST integral (SAI QRST. We hypothesized that adverse electrical remodeling predicts outcomes in MADIT II study participants. METHODS: Baseline orthogonal ECGs of 750 MADIT II study participants (448 [59.7%] ICD arm were analyzed. SAI QRST was measured as the arithmetic sum of absolute QRST integrals over all three orthogonal ECG leads. The primary endpoint was defined as sudden cardiac death (SCD or sustained ventricular tachycardia (VT/ventricular fibrillation (VF with appropriate ICD therapies. All-cause mortality served as a secondary endpoint. RESULTS: Adverse electrical remodeling in post-MI patients was characterized by wide QRS, increased magnitudes of spatial QRS and T vectors, J-point deviation, and QTc prolongation. In multivariable Cox regression analysis after adjustment for age, QRS duration, atrial fibrillation, New York Heart Association heart failure class and blood urea nitrogen, SAI QRST predicted SCD/VT/VF (HR 1.33 per 100 mV*ms (95%CI 1.11-1.59; P = 0.002, and all-cause death (HR 1.27 per 100 mV*ms (95%CI 1.03-1.55, P = 0.022 in both arms. No interaction with therapy arm and bundle branch block (BBB status was found. CONCLUSIONS: In MADIT II patients, increased SAI QRST is associated with increased risk of sustained VT/VF with appropriate ICD therapies and all-cause death in both ICD and in conventional medical therapy arms, and in patients with and without BBB. Further studies of SAI QRST are warranted.

  20. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies)

    OpenAIRE

    Costeloe, Kate L.; Hennessy, Enid M; Haider, Sadia; Stacey, Fiona; Marlow, Neil; Elizabeth S Draper

    2012-01-01

    Objective To determine survival and neonatal morbidity for babies born between 22 and 26 weeks’ gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks’ gestation. Design Prospective national cohort studies. Setting Maternity and neonatal units in England. Participants 3133 births between 22 and 26 weeks’ gestation in 2006; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks’ gestation...

  1. Major risk factors of maternal adverse outcome in women with two or more previous cesarean sections

    Directory of Open Access Journals (Sweden)

    Egić Amira

    2016-01-01

    Full Text Available Background/Aim. Maternal morbidity is defined as any condition that is attributed to or aggravated by pregnancy and childbirth that has a negative impact on the woman's wellbeing. In recent years, a growing trend of cesarean section rates can be seen throughout the world. The aim of this study was to assess factors that might have major impact on maternal adverse outcome in women with two or more previous cesarean sections. Methods. This retrospective study included women with single term pregnancy after two or more cesarean deliveries in a 10-year period (2004−2013 in the University Clinic “Narodni front” in Belgrade, Serbia. Medical records were reviewed for clinical data for maternal intraoperative and early postoperative complications regarding gestational age at delivery, the number of previous cesarean sections and mode of surgery (elective or emergency. Results. A total of 551 patients were included in the study. At 37 completed weeks delivered 14.1%, at 38 delivered 45.2% and at 39 completed weeks 40.7% patients. Women younger than 35 years more often delivered after 39 completed weeks compared with those over 35 years (69.2% vs 30.8%, p < 0.05. The overall rate of maternal complications in the study group was 16.5% with no statistical difference by gestational age at delivery. The overall rate of maternal adverse outcome was significantly less in the patients with three as compared with those with four or more cesareans (10.4% vs 66.7%, p < 0.05. There was a statistically significant difference between these groups of women regarding complications: scar dehiscence, the presence of adhesions, blood transfusion and admission in intensive care unit. Elective cesarean delivery was with less maternal complications compared with emergency cesarean deliveries (12.9% vs 27.3%, p < 0.05. Conclusion. Termination of pregnancy before completed 39 weeks does not decrease maternal morbidity. The major impact on maternal complications has the

  2. Influence of Malnutrition on Adverse Outcome in Children with Confirmed or Probable Viral Encephalitis: A Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Priyanka Singh

    2015-01-01

    Full Text Available A prospective observational study was conducted in a tertiary care teaching hospital from August 2008 to August 2009 to explore the independent predictors of adverse outcome in the patients with confirmed/probable viral encephalitis. The primary outcome variable was the incidence of adverse outcomes defined as death or severe neurological deficit such as loss of speech, motor deficits, behavioural problems, blindness, and cognitive impairment. Patients with confirmed or probable viral encephalitis were classified into two groups based on their Z-score of weight-for-age as per WHO growth charts. Group I. Patients with confirmed or probable viral encephalitis with weight-for-age (W/A Z-scores below −2SD were classified as undernourished. Group II. Patients with confirmed or probable viral encephalitis were classified as having normal nutritional status (weight-for-age Z-score >−2SD. A total of 114 patients were classified as confirmed or probable viral encephalitis based on detailed investigations. On multivariate logistic regression, undernutrition (adjusted OR: 5.05; 95% CI: 1.92 to 13.44 and requirement of ventilation (adjusted OR: 6.75; 95% CI: 3.63 to 77.34 were independent predictors of adverse outcomes in these patients. Thus, the results from our study highlight that the association between undernutrition and adverse outcome could be extended to the patients with confirmed/probable viral encephalitis.

  3. Apert Syndrome: Outcomes From the Australian Craniofacial Unit's Birth to Maturity Management Protocol.

    Science.gov (United States)

    David, David J; Anderson, Peter; Flapper, Walter; Syme-Grant, Jonathan; Santoreneos, Steven; Moore, Mark

    2016-07-01

    The complex, progressive, multisystem nature of Apert syndrome presents many challenges to managing surgeons. Based on the pioneering work of Paul Tessier, the senior author developed a multidisciplinary birth to maturity management protocol for Apert syndrome. Between 1975 and 2014 the Australian Craniofacial Unit has treated 174 Apert syndrome patients and 28 have completed full protocol management. This paper reviews the scientific contribution made to the management of Apert syndrome by the Australian Craniofacial Unit, the development and evolution of the protocol and presents comprehensive data on the surgical and nonsurgical craniofacial interventions, and outcomes for the 28 patients who have completed the programme; 26 had normal visual acuity, 22 had normal hearing, 20 achieved normal or nearly normal speech, 24 a functional class I occlusion, 18 completed mainstream schooling of whom at least 8 went on to tertiary education, at least 13 gained employment and 15 developed good social groups. These outcomes equal or exceed those presented by other authors and provide compelling evidence of the value of protocol management in clinical outcomes, in addition to their value in international collaboration, and scientific development of future therapeutic strategies for the management of Apert syndrome. PMID:27380568

  4. Monitoring of IVF birth outcomes in Finland: a data quality study

    Directory of Open Access Journals (Sweden)

    Hemminki Elina

    2004-03-01

    Full Text Available Abstract Background The collection of information on infertility treatments is important for the surveillance of potential health consequences and to monitor service provision. Study design We compared the coverage and outcomes of IVF children reported in aggregated IVF statistics, the Medical Birth Register (subsequently: MBR and research data based on reimbursements for IVF treatments in Finland in 1996–1998. Results The number of newborns were nearly equal in the three data sources (N = 4331–4384, but the linkage between the MBR and the research data revealed that almost 40% of the reported IVF children were not the same individuals. The perinatal outcomes in the three data sources were similar, excluding the much lower incidence of major congenital anomalies in the IVF statistics (157/10 000 newborns compared to other sources (409–422/10 000 newborns. Conclusion The differences in perinatal outcomes in the three data sets were in general minor, which suggests that the observed non-recording in the MBR is most likely unbiased.

  5. Obstetric and birth outcomes in pregnant women with epilepsy: A hospital-based study

    Directory of Open Access Journals (Sweden)

    Noor Haslina Othman

    2013-01-01

    Full Text Available Introduction : In addition to changes in seizure frequency, pregnant women with epilepsy (WWE are at increased risk of complications during pregnancy or delivery. In the absence of a nationwide WWE registry, hospital-based studies may provide important information regarding current management and outcomes in these patients. Objectives: The aims of this study were to determine changes in seizure frequency, and pregnancy and birth outcomes among pregnant WWE. Materials and Methods: We conducted a retrospective review of medical records of pregnant patients with epilepsy, who obtained medical care (from 2006 to 2011 at one of the general hospitals in the North-Eastern State of Malaysia. Data were collected for seizure frequency before and during the pregnancy, concurrent medications, pregnancy complications, and neonatal outcomes. Results: We reviewed records of 25 patients with a total of 33 different pregnancies. All patients were treated with antiepileptic medications during their pregnancies, with 42% monotherapy and 58% polytherapy. Seizure frequency decreased in 5 (15.2%, increased in 18 (54.5% and unchanged in 10 (30.3% cases of pregnancies. Pregnancy complications were anemia, gestational diabetes mellitus, gestational hypertension, intrauterine growth retardation, premature rupture of membrane, and vaginal bleeding. Preterm deliveries were recorded in 11 (33.3% infants. Conclusion: In our setting, many patients were being on polytherapy during their pregnancies. This underscores the need for planned pregnancies so that antiepileptic medications can be optimized prior to pregnancy.

  6. A study of neonatal outcome associated with preterm birth in a tertiary care hospital

    International Nuclear Information System (INIS)

    Preterm birth is the most significant problem in current obstetric practice and according to WHO is the direct cause accounting for 24% of neonatal deaths. Objective: To assess frequency and neonatal outcome in patients with preterm birth. Methodology: A prospective descriptive study was conducted at Gynae Unit III Jinnah Hospital Lahore over a period of one year (from 1st July 2011 to 30th June included in the study. For data collection two groups were made depending upon duration of pregnancy. Group l was allotted to women who were pregnant 2012) in collaboration with Paediatrics department. All labouring women who presented after 28 weeks and before 37 completed weeks of gestation were less ( ) than 32 weeks of gestation. Data was collected and analyzed by SPSS version 16. Results: During the study period total 5171 deliveries took place. Out of 5171 neonates born, 460 were preterm making the frequency of 8.86%. Majority 62.82% were > 32 weeks of gestation, 67.39% were male, 57.60% were > 1.5 kg by weight, 57.17% delivered vaginally and 80.86% were born alive. Neonatal morbidity was more common in neonates less than 32 weeks of gestation. Perinatal mortality was 10.48% in this study. Conclusion: Neonatal morbidity and mortality is more common in neonates less than 32 weeks of gestation, this can be improved by improving prenatal health services and advanced neonatal care. (author)

  7. C-reactive protein as a predictor of adverse outcome in patients with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    A S Sheikh

    2012-01-01

    Full Text Available Background and Objectives: The acute-phase reactant C-reactive protein (CRP has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events. The objective of this study was to evaluate the prognostic value of CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. Patients and Methods: This prospective, single-centered study was carried out by the Department of Pathology in collaboration with the Department of Cardiology, Bolan Medical College Complex Quetta, Balochistan, Pakistan from January 2009 to December 2009. We studied 963 consecutive patients presenting with chest pain to Accident and Emergency Department. Patients were divided into four groups. Group-1 comprised patients with unstable angina; group-2 included patients with acute ST elevation myocardial infarction (STEMI; group-3 comprised patients with Non-ST elevation myocardial infarction (Non-STEMI and group-4 was the control group. All four groups were followed-up for 90 days for occurrence of cardiovascular events. Results: The CRP was elevated (>3 mg/L among 27.6% patients in Group-1; 70.9% in group- 2; 77.9% in group-3 and 5.3% in the control group. Among cases with elevated CRP, 92.1% had a cardiac event compared to 34.3% among patients with CRP £3 mg/L (P < 0.0001. The mortality was significantly higher (P < 0.0001 in group-2 (8.9% and group-3 (11.9% as compared to group-1 (2.1%. There was no cardiac event or mortality in Group-4. Conclusions: Elevated CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications.

  8. Impact of Coastal Pollution on Childhood Disabilities and Adverse Pregnancy Outcomes: The Case of Bangladesh

    Directory of Open Access Journals (Sweden)

    Juma Rahman

    2012-07-01

    Full Text Available Objective: The objective of this review was to explore the situation of coastal water pollution and its impact on child health and pregnancy outcomes in Bangladesh. Background: Globally coastal pollution is of greater significance than inland’s for its huge resources and contribution to livelihood. As a result it has been a source of increased Global Burden of Disease by means of consumption of seafood, involvement in risky jobs, and exposure to water related disastrous events. Almost sixty percent of the world’s population is at risk of costal contamination and developing countries like Bangladesh, geographically located at the tip of the Bay of Bengal, are facing significant challenges by this form of pollution. Method: This study was based on a critical review of published literature and unpublished documents from 1972 to 2011 retrieved from databases of scientific publications, from public-access search engines, reports from government, international organizations, and non-government agencies, and personal communications. Discussion: Huge noxious pollutants including heavy metals, oil spill and redionucleotides were found in the Bay of Bengal, those have enormous adverse impacts on child health and pregnancy outcomes. This review focuses on children and pregnant women because of their vulnerable physiological conditions to the impacts of environmental factors. The physiological systems of children and fetuses are developing fast and usually are sensitive to disruptions induced by environmental pollutants and exposures in utero increase the risk of future toxic insults. Conclusion: The coastal zone of Bangladesh is one of the vulnerable zones in the world which is predicted to disappear due to climate change impacts. This areas face huge weather-related disasters due to continuous changing coastal-configuration and man-made pollutions. However, these observations are indecisive due to limitations of supportive evidence. Therefore, further

  9. A Workflow to Investigate Exposure and Pharmacokinetic Influences on High-Throughput in Vitro Chemical Screening Based on Adverse Outcome Pathways

    Science.gov (United States)

    Background: Adverse outcome pathways (AOPs) link adverse effects in individuals or populations to a molecular initiating event (MIE) that can be quantified using in vitro methods. Practical application of AOPs in chemical-specific risk assessment requires incorporation of knowled...

  10. The Effect of a Universal Cervical Length Screening Program on Antepartum Management and Birth Outcomes

    Science.gov (United States)

    Shainker, Scott A.; Modest, Anna M.; Hacker, Michele R.; Ralston, Steven J.

    2016-01-01

    Objective The objective of this study was to evaluate the effect of a universal cervical length screening program on the incidence of antepartum interventions. Study Design This retrospective cohort study included women delivering ≥ 20 weeks of gestation with singleton pregnancies before and after implementing universal cervical length screening. Antepartum interventions included admission for threatened preterm birth, ≥ 2 cervical length measurements, cervical cerclage, neonatology consultation, betamethasone, antibiotic administration for preterm premature rupture of membranes, and tocolysis. Results There were 1,131 women—506 before the screening program (unexposed) and 625 afterward (exposed). The screening program resulted in significantly more women screened (3.0 vs. 69.9%, p < 0.0001). The exposed group was more likely to undergo ≥ 1 intervention (20.0 vs. 9.5%, p < 0.0001); specifically, admission for threatened preterm birth (3.8 vs. 1.8%, p = 0.04) and ≥ 2 cervical measurements (11.2 vs. 2.0%, p < 0.001). Other interventions were similar between groups (all p ≥ 0.06). Median gestation length was significantly longer in the exposed (39.6 weeks [interquartile, IQR: 38.6–40.4] vs. 39.0 weeks [IQR: 38.0–40.0, p < 0.001]); however, preterm delivery incidence was unaffected (9.4 vs. 10.9%, p = 0.43). Remaining neonatal outcomes were similar (all p ≥ 0.14). Conclusion Implementing universal cervical length screening significantly increased the proportion of women undergoing ≥ 1 antepartum intervention. With the exception of a modestly prolonged gestation, other outcomes were unaffected. PMID:27280063

  11. The Effect of a Universal Cervical Length Screening Program on Antepartum Management and Birth Outcomes.

    Science.gov (United States)

    Shainker, Scott A; Modest, Anna M; Hacker, Michele R; Ralston, Steven J

    2016-04-01

    Objective The objective of this study was to evaluate the effect of a universal cervical length screening program on the incidence of antepartum interventions. Study Design This retrospective cohort study included women delivering ≥ 20 weeks of gestation with singleton pregnancies before and after implementing universal cervical length screening. Antepartum interventions included admission for threatened preterm birth, ≥ 2 cervical length measurements, cervical cerclage, neonatology consultation, betamethasone, antibiotic administration for preterm premature rupture of membranes, and tocolysis. Results There were 1,131 women-506 before the screening program (unexposed) and 625 afterward (exposed). The screening program resulted in significantly more women screened (3.0 vs. 69.9%, p < 0.0001). The exposed group was more likely to undergo ≥ 1 intervention (20.0 vs. 9.5%, p < 0.0001); specifically, admission for threatened preterm birth (3.8 vs. 1.8%, p = 0.04) and ≥ 2 cervical measurements (11.2 vs. 2.0%, p < 0.001). Other interventions were similar between groups (all p ≥ 0.06). Median gestation length was significantly longer in the exposed (39.6 weeks [interquartile, IQR: 38.6-40.4] vs. 39.0 weeks [IQR: 38.0-40.0, p < 0.001]); however, preterm delivery incidence was unaffected (9.4 vs. 10.9%, p = 0.43). Remaining neonatal outcomes were similar (all p ≥ 0.14). Conclusion Implementing universal cervical length screening significantly increased the proportion of women undergoing ≥ 1 antepartum intervention. With the exception of a modestly prolonged gestation, other outcomes were unaffected. PMID:27280063

  12. Internal exposure dynamics drive the Adverse Outcome Pathways of synthetic glucocorticoids in fish

    Science.gov (United States)

    Margiotta-Casaluci, Luigi; Owen, Stewart F.; Huerta, Belinda; Rodríguez-Mozaz, Sara; Kugathas, Subramanian; Barceló, Damià; Rand-Weaver, Mariann; Sumpter, John P.

    2016-02-01

    The Adverse Outcome Pathway (AOP) framework represents a valuable conceptual tool to systematically integrate existing toxicological knowledge from a mechanistic perspective to facilitate predictions of chemical-induced effects across species. However, its application for decision-making requires the transition from qualitative to quantitative AOP (qAOP). Here we used a fish model and the synthetic glucocorticoid beclomethasone dipropionate (BDP) to investigate the role of chemical-specific properties, pharmacokinetics, and internal exposure dynamics in the development of qAOPs. We generated a qAOP network based on drug plasma concentrations and focused on immunodepression, skin androgenisation, disruption of gluconeogenesis and reproductive performance. We showed that internal exposure dynamics and chemical-specific properties influence the development of qAOPs and their predictive power. Comparing the effects of two different glucocorticoids, we highlight how relatively similar in vitro hazard-based indicators can lead to different in vivo risk. This discrepancy can be predicted by their different uptake potential, pharmacokinetic (PK) and pharmacodynamic (PD) profiles. We recommend that the development phase of qAOPs should include the application of species-species uptake and physiologically-based PK/PD models. This integration will significantly enhance the predictive power, enabling a more accurate assessment of the risk and the reliable transferability of qAOPs across chemicals.

  13. Systemic effects of periodontitis: lessons learned from research on atherosclerotic vascular disease and adverse pregnancy outcomes.

    Science.gov (United States)

    Papapanou, Panos N

    2015-12-01

    Studies conducted over the past 25 years have focussed on the role of periodontitis, an inflammatory condition of microbial aetiology that destroys the tooth-supporting tissues, as a systemic inflammatory stressor that can act as an independent risk factor of atherosclerotic vascular disease (AVSD) and adverse pregnancy outcomes (APOs). It has been suggested that periodontitis-associated bacteraemias and systemic dissemination of inflammatory mediators produced in the periodontal tissues may result in systemic inflammation and endothelial dysfunction, and that bacteria of oral origin may translocate into the feto-placental unit. Epidemiological studies largely support an association between periodontitis and ASVD/APOs, independently of known confounders; indeed, periodontitis has been shown to confer statistically significantly elevated risk for clinical events associated with ASVD and APOs in multivariable adjustments. On the other hand, intervention studies demonstrate that although periodontal therapy reduces systemic inflammation and improves endothelial function, it has no positive effect on the incidence of APOs. Studies of the effects of periodontal interventions on ASVD-related clinical events are lacking. This review summarises key findings from mechanistic, association and intervention studies and attempts to reconcile the seemingly contradictory evidence that originates from different lines of investigation.

  14. ED 07-4 IS EXERCISE-INDUCED HYPERTENSION ASSOCIATED WITH ADVERSE CARDIOVASCULAR OUTCOMES?

    Science.gov (United States)

    Sharman, James

    2016-09-01

    Millions of clinical exercise stress tests are conducted annually worldwide. The fundamental rationale underlying the conduct of these tests is that cardiovascular irregularities may be revealed during an exercise bout that would otherwise remain unnoticed if testing was only conducted under resting conditions. In order to reveal electrocardiographic abnormalities indicative of cardiac disease, maximal intensity exercise may need to be undertaken, whereas the presence of hypertension can be revealed by the blood pressure response at low to moderate intensity exercise. Therefore, exercise blood pressure measured carefully under standardised conditions should be a useful tool to identify individuals at increased cardiovascular risk. Independent investigators have consistently shown that exercise blood pressure at low to moderate intensities predicts adverse cardiovascular outcomes independent from resting blood pressure and conventional cardiovascular risk factors. This talk will present evidence in support of exercise-induced hypertension as a clinical observation requiring additional follow up care. Future needs in terms of better understanding the mechanisms of exercise hypertension and determination of exercise hypertension thresholds will also be detailed. PMID:27642909

  15. Circulating angiogenic factors and risk of adverse maternal and perinatal outcomes in twin pregnancies with suspected preeclampsia.

    Science.gov (United States)

    Rana, Sarosh; Hacker, Michele R; Modest, Anna Merport; Salahuddin, Saira; Lim, Kee-Hak; Verlohren, Stefan; Perschel, Frank H; Karumanchi, S Ananth

    2012-08-01

    To evaluate whether angiogenic factor levels correlate with preeclampsia-related adverse maternal and perinatal outcomes in women with twin pregnancy, we studied 79 women with suspected preeclampsia in the 3rd trimester. Antiangiogenic soluble fms-like tyrosine kinase-1 (sFlt-1) and proangiogenic placental growth factor (PlGF) were measured at presentation on an automated platform. An adverse outcome was defined as hemolysis, elevated liver enzymes, and low platelets syndrome; disseminated intravascular coagulation; abruption; pulmonary edema; cerebral hemorrhage; maternal, fetal, and neonatal death; eclampsia; acute renal failure; small for gestational age; and indicated delivery. All outcomes were ascertained 2 weeks after initial evaluation. Comparing the 52 women (65.8%) who experienced an adverse outcome with the 27 women (34.2%) without an adverse outcome, the median sFlt-1 was elevated (11461.5 pg/mL [8794.0-14847.5] versus 7495.0 pg/mL [3498.0-10482.0; P=0.0004]), PlGF was reduced (162.5 pg/mL [98.0-226.5] versus 224.0 pg/mL [156.0-449.0]; P=0.005), and sFlt-1/PlGF ratio was elevated (74.2 [43.5-110.5] versus 36.2 [7.1-71.3]; P=0.0005). Among those presenting preeclampsia, the sFlt-1/PlGF ratio at the time of initial evaluation is associated with subsequent adverse maternal and perinatal outcomes. These findings are similar to those in singleton pregnancies and may implicate common pathogenic pathways. PMID:22753210

  16. Adverse pregnancy outcomes after exposure to methylphenidate or atomoxetine during pregnancy

    Directory of Open Access Journals (Sweden)

    Bro SP

    2015-01-01

    Full Text Available Søren Pauli Bro,1 Maiken Ina Siegismund Kjaersgaard,2 Erik Thorlund Parner,2 Merete Juul Sørensen,3 Jørn Olsen,4 Bodil Hammer Bech,4 Lars Henning Pedersen,4,5 Jakob Christensen,6,7 Mogens Vestergaard11Research Unit and Section for General Practice, Department of Public Health, 2Section for Biostatistics, Department of Public Health, Aarhus University, 3Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, 4Section for Epidemiology, Department of Public Health, 5Department of Clinical Medicine – Obstetrics and Gynecology, Aarhus University, 6Department of Clinical Pharmacology, 7Department of Neurology, Aarhus University Hospital, Aarhus, DenmarkObjective: To determine if prenatal exposure to methylphenidate (MPH or atomoxetine (ATX increases the risk of adverse pregnancy outcomes in women with attention deficit/hyperactivity disorder (ADHD.Materials and methods: This was a population-based cohort study of all pregnancies in Denmark from 1997 to 2008. Information on use of ADHD medication, ADHD diagnosis, and pregnancy outcomes was obtained from nationwide registers.Results: We identified 989,932 pregnancies, in which 186 (0.02% women used MPH/ATX and 275 (0.03% women had been diagnosed with ADHD but who did not take MPH/ATX. Our reference pregnancies had no exposure to MPH/ATX and no ADHD diagnosis. Exposure to MPH/ATX was associated with an increased risk of spontaneous abortion (SA; ie, death of an embryo or fetus in the first 22 weeks of gestation (adjusted relative risk [aRR] 1.55, 95% confidence interval [CI] 1.03–2.36. The risk of SA was also increased in pregnancies where the mother had ADHD but did not use MPH/ATX (aRR 1.56, 95% CI 1.11–2.20. The aRR of Apgar scores <10 was increased among exposed women (aRR 2.06, 95% CI 1.11–3.82 but not among unexposed women with ADHD (aRR 0.99, 95% CI 0.48–2.05.Conclusion: MPH/ATX was associated with a higher risk of SA, but our study indicated that it may at

  17. The association of season and temperature with adverse pregnancy outcome in two German states, a time-series analysis.

    Directory of Open Access Journals (Sweden)

    Jennyfer Wolf

    Full Text Available BACKGROUND: A seasonality of low birth weight (LBW and preterm birth (PTB has been described for most regions and there is evidence that this pattern is caused by ambient outdoor temperature. However, the association as such, the direction of effect and the critical time of exposure remain controversial. METHODS: Logistic, time-series regression was performed on nearly 300,000 births from two German states to study the association between season and daily mean temperature and changes in daily proportions of term LBW (tLBW or PTB. Analyses were adjusted for time-varying factors. Temperature exposures were examined during different periods of pregnancy. RESULTS: Weak evidence for an association between season of conception, season of birth or ambient outdoor temperature and tLBW or PTB was found. Results of analyses of temperature were not consistent between the two states. Different sources of bias which would have artificially led to stronger findings were detected and are described. CONCLUSIONS: No clear evidence for an association between season of conception, season of birth or temperature and tLBW or PTB was found. In the study of pregnancy outcome different sources of bias can be identified which can potentially explain heterogeneous findings of the past.

  18. Developmental outcome of low birth-weight and preterm newborns: a re-view of current evidence

    Directory of Open Access Journals (Sweden)

    Farin Soleimani

    2013-12-01

    Full Text Available Low birth weight (LBW and preterm birth are one the most important causes of death in the world and therefore are considered as one of the major health problems. Global statistics demonstrates an increase in the prevalence of low birth weight in the developing countries. Low birth weight infants are exposed to complications such as major neurosensory impairements, cerebral palsy, cognitive and language delays, neuromotor developmental delay, blindness and hearing loss, behavioral and psychosocial disorders, learning difficulties and dysfunction in scholastic performances. The majority of infant's death and developmental disorders were due to disorders relating to prematurity and unspecified low birth weight. Infants weighing less than 2500 g, is a major determinant of both neonatal and infant mortality rates and, together with congenital anomalies (e.g., cardiac, central nervous system, and respiratory, contributes significantly to childhood morbidity. Various studies indicate that low birth weight infants are suffering from physiological and psychosocial disabilities, two to three times more than the other children. At school age, preterm and low birth weight infants have poorer physical growth, cognitive function, and school performance. These disadvantages appear to persist into adulthood and therefore have broad implications for society. Although the survival rates have increased dramatically and the incidence of morbidities has decreased, the complications are still considered to be associated with economical and social burdens. Most children with Low birth weight suffer from multiple disabilities. Therefore, they need special and consistent care. On demand of reducing the infant mortality rate, the need to decrease the complications in low birth weight and preterm infants should be considered by the policy makers in health care system. In this review article, we assessed current evidences on developmental outcomes of low birth weight and

  19. Relation between change in blood pressure in acute stroke and risk of early adverse events and poor outcome

    DEFF Research Database (Denmark)

    Sandset, Else C; Murray, Gordon D; Bath, Philip M W;

    2012-01-01

    The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of candesartan in acute stroke. In the present analysis we aim to investigate the effect of change in blood pressure during the first 2 days of stroke on the risk of early adverse events and poor outcome....

  20. Adverse Outcome Pathway (AOP) for a Mutagenic Mode of Action for Cancer: AFB1 and Hepatocellular Carcinoma (HCC)

    Science.gov (United States)

    AOPs provide a framework to describe a sequence of measureable key events (KEs), beginning with a molecular initiating event (MIE), followed by a series of identified KEs linked to one another by KE Relationships (KERs), all anchored by a specific adverse outcome (AO). Each KE/KE...

  1. Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

    NARCIS (Netherlands)

    Ravelli, A. C. J.; Jager, K. J.; de Groot, M. H.; Erwich, J. J. H. M.; Rijninks-van Driel, G. C.; Tromp, M.; Eskes, M.; Abu-Hanna, A.; Mol, B. W. J.

    2011-01-01

    Objective To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care. Design Population-based cohort study from 2000 up to and including 2006. Setting The Netherlands Perinatal Reg

  2. Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

    NARCIS (Netherlands)

    A.C.J. Ravelli; K.J. Jager; M.H. de Groot; J.J.H.M. Erwich; G.C. Rijninks-van Driel; M. Tromp; M. Eskes; A. Abu-Hanna; B.W.J. Mol

    2011-01-01

    To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care. Population-based cohort study from 2000 up to and including 2006. The Netherlands Perinatal Registry. A total of 751,926

  3. Adverse pregnancy outcome in women with mild glucose intolerance: is there a clinically meaningful threshold value for glucose?

    DEFF Research Database (Denmark)

    Jensen, Dorte; Lauridsen, Lars Korsholm; Ovesen, Per Glud;

    2008-01-01

    The diagnostic criteria of gestational diabetes mellitus (GDM) have been based on the risk of future maternal diabetes rather than the short-term risk of mother and infant. Our aim was to illustrate the relation between various adverse pregnancy outcomes and maternal glucose levels in women...

  4. Crown-rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies?

    DEFF Research Database (Denmark)

    Johansen, Mathias; Oldenburg, A.; Rosthøj, Susanne;

    2014-01-01

    OBJECTIVES: To evaluate the usefulness of first-trimester crown-rump length (CRL) discordance in predicting adverse outcome in twin pregnancies. METHODS: This retrospective study included a large cohort retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising a...

  5. Perinatal outcome of 12,021 singleton and 3108 twin births after non-IVF-assisted reproduction: a cohort study.

    Science.gov (United States)

    Ombelet, Willem; Martens, Guy; De Sutter, Petra; Gerris, Jan; Bosmans, Eugene; Ruyssinck, Gunther; Defoort, Paul; Molenberghs, Geert; Gyselaers, Wilfried

    2006-04-01

    Perinatal outcome of pregnancies caused by assisted reproduction technique (ART) is substantially worse when compared with pregnancies following natural conception. We investigated the possible risks of non-IVF ART on perinatal health. We conducted a retrospective cohort study with two exposure groups: a study group of pregnancies after controlled ovarian stimulation (COS), with or without artificial insemination (AI), and a naturally conceived comparison group. We used the data from the regional registry of all hospital deliveries in the Dutch-speaking part of Belgium during the period from January 1993 until December 2003 to investigate differences in perinatal outcome of singleton and twin pregnancies. 12 021 singleton and 3108 twin births could be selected. Naturally conceived subjects were matched for maternal age, parity, fetal sex and year of birth. The main outcome measures were duration of pregnancy, birth weight, perinatal morbidity and perinatal mortality. Our overall results showed a significantly higher incidence of prematurity (<32 and <37 weeks), low and very low birth weight, transfer to the neonatal intensive care unit and most neonatal morbidity parameters for COS/AI singletons. Twin pregnancies resulting from COS/AI showed an increased rate of neonatal mortality, assisted ventilation and respiratory distress syndrome. After excluding same-sex twin sets, COS/AI twin pregnancies were at increased risk for extreme prematurity and very low birth weight. In conclusion, COS/AI singleton and twin pregnancies are significantly disadvantaged compared to naturally conceived children.

  6. Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort.

    NARCIS (Netherlands)

    Zeitlin, J.; Draper, E.S.; Kollee, L.A.A.; Milligan, D.; Boerch, K.; Agostino, R.; Gortner, L.; Reempts, P. van; Chabernaud, J.L.; Gadzinowski, J.; Breart, G.; Papiernik, E.

    2008-01-01

    OBJECTIVES: Advances in perinatal medicine increased survival after very preterm birth in all countries, but comparative population-based data on these births are not readily available. This analysis contrasts the rates and short-term outcome of live births before 32 weeks of gestation in 10 Europea

  7. Impact of Different Childhood Adversities on 1-Year Outcomes of Psychotic Disorder in the Genetics and Psychosis Study.

    Science.gov (United States)

    Trotta, Antonella; Murray, Robin M; David, Anthony S; Kolliakou, Anna; O'Connor, Jennifer; Di Forti, Marta; Dazzan, Paola; Mondelli, Valeria; Morgan, Craig; Fisher, Helen L

    2016-03-01

    While the role of childhood adversity in increasing the risk of psychosis has been extensively investigated, it is not clear what the impact of early adverse experiences is on the outcomes of psychotic disorders. Therefore, we investigated associations between childhood adversity and 1-year outcomes in 285 first-presentation psychosis patients. Exposure to childhood adversity prior to 17 years of age was assessed using the Childhood Experience of Care and Abuse Questionnaire. Data on illness course, symptom remission, length of psychiatric hospitalization, compliance with medication, employment, and relationship status were extracted from clinical records for the year following first contact with mental health services for psychosis. Seventy-one percent of patients reported exposure to at least 1 type of childhood adversity (physical abuse, sexual abuse, parental separation, parental death, disrupted family arrangements, or being taken into care). No robust associations were found between childhood adversity and illness course or remission. However, childhood physical abuse was associated with almost 3-fold increased odds of not being in a relationship at 1-year follow-up compared to patients who did not report such adverse experiences. There was also evidence of a significant association between parental separation in childhood and longer admissions to psychiatric wards during 1-year follow-up and 2-fold increased odds of noncompliance with medication compared to those not separated from their parents. Therefore, our findings suggest that there may be some specificity in the impact of childhood adversity on service use and social functioning among psychosis patients over the first year following presentation to mental health services. PMID:26373540

  8. Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

    Science.gov (United States)

    van der Ven, A. J.; Schaaf, J. M.; van Os, M. A.; de Groot, C. J. M.; Haak, M. C.; Pajkrt, E.; Mol, B. W. J.

    2014-01-01

    Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1) labor onset and delivery in primary care; (2) labor onset in primary care and delivery in secondary care; (3) labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79)). Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27) and low Apgar score (aOR 1.95; 95% CI 1.53–2.48) were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care. PMID:25610468

  9. Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

    Directory of Open Access Journals (Sweden)

    A. J. van der Ven

    2014-01-01

    Full Text Available Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1 labor onset and delivery in primary care; (2 labor onset in primary care and delivery in secondary care; (3 labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79. Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27 and low Apgar score (aOR 1.95; 95% CI 1.53–2.48 were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care.

  10. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.; Keirse, M.J.N.C.; Zee, J. van der; Berghs, G.A.H.

    1996-01-01

    Objective: To investigate the relation between the intended place of birth (home or hospital) and perinatal outcome in women with low risk pregnancies after controlling for parity and social, medical, and obstetric background. Design: Analysis of prospective data from midwives and their clients. Set

  11. Postoperative adverse outcomes in intellectually disabled surgical patients: a nationwide population-based study.

    Directory of Open Access Journals (Sweden)

    Jui-An Lin

    Full Text Available BACKGROUND: Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients. METHODS: A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact. RESULTS: Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37, pneumonia (odds ratio 2.01, 1.61 to 2.49, postoperative bleeding (odds ratio 1.35, 1.09 to 1.68 and septicemia (odds ratio 2.43, 1.85 to 3.21 without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability. CONCLUSION: Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients.

  12. Limitations of toxicity characterization in life cycle assessment: Can adverse outcome pathways provide a new foundation?

    Science.gov (United States)

    Gust, Kurt A; Collier, Zachary A; Mayo, Michael L; Stanley, Jacob K; Gong, Ping; Chappell, Mark A

    2016-07-01

    Life cycle assessment (LCA) has considerable merit for holistic evaluation of product planning, development, production, and disposal, with the inherent benefit of providing a forecast of potential health and environmental impacts. However, a technical review of current life cycle impact assessment (LCIA) methods revealed limitations within the biological effects assessment protocols, including: simplistic assessment approaches and models; an inability to integrate emerging types of toxicity data; a reliance on linear impact assessment models; a lack of methods to mitigate uncertainty; and no explicit consideration of effects in species of concern. The purpose of the current study is to demonstrate that a new concept in toxicological and regulatory assessment, the adverse outcome pathway (AOP), has many useful attributes of potential use to ameliorate many of these problems, to expand data utility and model robustness, and to enable more accurate and defensible biological effects assessments within LCIA. Background, context, and examples have been provided to demonstrate these potential benefits. We additionally propose that these benefits can be most effectively realized through development of quantitative AOPs (qAOPs) crafted to meet the needs of the LCIA framework. As a means to stimulate qAOP research and development in support of LCIA, we propose 3 conceptual classes of qAOP, each with unique inherent attributes for supporting LCIA: 1) mechanistic, including computational toxicology models; 2) probabilistic, including Bayesian networks and supervised machine learning models; and 3) weight of evidence, including models built using decision-analytic methods. Overall, we have highlighted a number of potential applications of qAOPs that can refine and add value to LCIA. As the AOP concept and support framework matures, we see the potential for qAOPs to serve a foundational role for next-generation effects characterization within LCIA. Integr Environ Assess Manag

  13. Vital Sign Prediction of Adverse Maternal Outcomes in Women with Hypovolemic Shock: The Role of Shock Index.

    Directory of Open Access Journals (Sweden)

    Alison M El Ayadi

    Full Text Available To determine the optimal vital sign predictor of adverse maternal outcomes in women with hypovolemic shock secondary to obstetric hemorrhage and to develop thresholds for referral/intensive monitoring and need for urgent intervention to inform a vital sign alert device for low-resource settings.We conducted secondary analyses of a dataset of pregnant/postpartum women with hypovolemic shock in low-resource settings (n = 958. Using receiver-operating curve analysis, we evaluated the predictive ability of pulse, systolic blood pressure, diastolic blood pressure, shock index, mean arterial pressure, and pulse pressure for three adverse maternal outcomes: (1 death, (2 severe maternal outcome (death or severe end organ dysfunction morbidity; and (3 a combined severe maternal and critical interventions outcome comprising death, severe end organ dysfunction morbidity, intensive care admission, blood transfusion ≥ 5 units, or emergency hysterectomy. Two threshold parameters with optimal rule-in and rule-out characteristics were selected based on sensitivities, specificities, and positive and negative predictive values.Shock index was consistently among the top two predictors across adverse maternal outcomes. Its discriminatory ability was significantly better than pulse and pulse pressure for maternal death (p<0.05 and p<0.01, respectively, diastolic blood pressure and pulse pressure for severe maternal outcome (p<0.01, and systolic and diastolic blood pressure, mean arterial pressure and pulse pressure for severe maternal outcome and critical interventions (p<0.01. A shock index threshold of ≥ 0.9 maintained high sensitivity (100.0 with clinical practicality, ≥ 1.4 balanced specificity (range 70.0-74.8 with negative predictive value (range 93.2-99.2, and ≥ 1.7 further improved specificity (range 80.7-90.8 without compromising negative predictive value (range 88.8-98.5.For women with hypovolemic shock from obstetric hemorrhage, shock index was

  14. Poverty, Pregnancy, and Birth Outcomes: A Study of the Earned Income Tax Credit

    Science.gov (United States)

    Rehkopf, David H.

    2015-01-01

    Background Economic interventions are increasingly recognized as a mechanism to address perinatal health outcomes among disadvantaged groups. In the United States, the earned income tax credit (EITC) is the largest poverty alleviation program. Little is known about its effects on perinatal health among recipients and their children. We exploit quasi-random variation in the size of EITC payments over time to examine the effects of income on perinatal health. Methods The study sample includes women surveyed in the 1979 National Longitudinal Survey of Youth (N=2,985) and their children born during 1986–2000 (N=4,683). Outcome variables include utilization of prenatal and postnatal care, use of alcohol and tobacco during pregnancy, term birth, birthweight, and breast-feeding status. We examine the health effects of both household income and EITC payment size using multivariable linear regressions. We employ instrumental variables analysis to estimate the causal effect of income on perinatal health, using EITC payment size as an instrument for household income. Results We find that household income and EITC payment size are associated with improvements in several indicators of perinatal health. Instrumental variables analysis, however, does not reveal a causal association between household income and these health measures. Conclusions Our findings suggest that associations between income and perinatal health may be confounded by unobserved characteristics, but that EITC income improves perinatal health. Future studies should continue to explore the impacts of economic interventions on perinatal health outcomes, and investigate how different forms of income transfers may have different impacts. PMID:26212041

  15. A comparison of sexual outcomes in primiparous women experiencing vaginal and caesarean births

    Directory of Open Access Journals (Sweden)

    Khajehei M

    2009-01-01

    Full Text Available Background and Objective: We conducted this study to evaluate and compare postpartum sexual functioning after vaginal and caesarean births. Materials and Methods: This was a cross-sectional study that was carried out in postnatal health care in a hospital. A total of 50 primiprous women who had given birth 6-12 months ago and came to the hospital for postnatal care were asked to join the study. Forty of the women completed the entire questionnaire. Among these women, 20 delivered spontaneously with mediolateral episiotomy and 20 had elective caesarean section. Sexual function was evaluated by a validated, self-created questionnaire. A statistical evaluation was carried out by SPSS v.11. A two-part self-created validated questionnaire for data collection was administered regarding sexual function prior to pregnancy and 6-12 months postpartum. Results: The median time to restart intercourse in the normal vaginal delivery with episiotomy (NVD/epi group was 40 days and in the caesarean section (C/S group was 10 days postpartum. The most common problems in the NVD/epi group was decreased libido (80%, sexual dissatisfaction (65%, and vaginal looseness (55%. In the C/S group, the most common problems were vaginal dryness (85%, sexual dissatisfaction (60%, and decreased libido (35%. There were clinically significant differences between the two groups regarding sexual outcomes, but these differences were not statically significant. Conclusion: Postnatal sexual problems were very common after both NVD/epi and C/S. Because sexual problems are so prevalent during the postpartum period, clinicians should draw more attention to the women′s sexual life and try to improve their quality of life after delivery.

  16. Maternal drinking water arsenic exposure and perinatal outcomes in Inner Mongolia, China

    Science.gov (United States)

    Exposure to high levels of arsenic has been reported to increase adverse birth outcomes including spontaneous abortion, preterm birth, and low birthweight. This study evaluated the relationship between maternal arsenic exposure and perinatal endpoints (term birthweight, preterm ...

  17. Attention-deficit/hyperactivity disorder and adverse health outcomes in adults.

    Science.gov (United States)

    Spencer, Thomas J; Faraone, Stephen V; Tarko, Laura; McDermott, Katie; Biederman, Joseph

    2014-10-01

    Whereas the adverse impact of attention-deficit/hyperactivity disorder (ADHD) on emotional and psychosocial well-being has been well investigated, its impact on physical health has not. The main aim of this study was to assess the impact of ADHD on lifestyle behaviors and measures of adverse health risk indicators. Subjects were 100 untreated adults with ADHD and 100 adults without ADHD of similar age and sex. Unhealthy lifestyle indicators included assessments of bad health habits, frequency of visits to healthcare providers, and follow through with recommended prophylactic tests. Assessments of adverse health risk indicators included measurements of cardiovascular and metabolic parameters, weight, body mass index, and waist circumference. No differences were identified in health habits between subjects with and without ADHD, but robust differences were found in a wide range of adverse health risk indicators. ADHD is associated with an adverse impact in health risk indicators well known to be associated with high morbidity and mortality. PMID:25211634

  18. Perinatal outcomes in a South Asian setting with high rates of low birth weight

    Directory of Open Access Journals (Sweden)

    Joseph K S

    2009-02-01

    Full Text Available Abstract Background It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference. Methods Population-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA live births were identified using both a recent Canadian and an older Indian fetal growth standard. Results The low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and Conclusion High rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories.

  19. APCR, factor V gene known and novel SNPs and adverse pregnancy outcomes in an Irish cohort of pregnant women

    LENUS (Irish Health Repository)

    Sedano-Balbas, Sara

    2010-03-10

    Abstract Background Activated Protein C Resistance (APCR), a poor anticoagulant response of APC in haemostasis, is the commonest heritable thrombophilia. Adverse outcomes during pregnancy have been linked to APCR. This study determined the frequency of APCR, factor V gene known and novel SNPs and adverse outcomes in a group of pregnant women. Methods Blood samples collected from 907 pregnant women were tested using the Coatest® Classic and Modified functional haematological tests to establish the frequency of APCR. PCR-Restriction Enzyme Analysis (PCR-REA), PCR-DNA probe hybridisation analysis and DNA sequencing were used for molecular screening of known mutations in the factor V gene in subjects determined to have APCR based on the Coatest® Classic and\\/or Modified functional haematological tests. Glycosylase Mediated Polymorphism Detection (GMPD), a SNP screening technique and DNA sequencing, were used to identify SNPs in the factor V gene of 5 APCR subjects. Results Sixteen percent of the study group had an APCR phenotype. Factor V Leiden (FVL), FV Cambridge, and haplotype (H) R2 alleles were identified in this group. Thirty-three SNPs; 9 silent SNPs and 24 missense SNPs, of which 20 SNPs were novel, were identified in the 5 APCR subjects. Adverse pregnancy outcomes were found at a frequency of 35% in the group with APCR based on Classic Coatest® test only and at 45% in the group with APCR based on the Modified Coatest® test. Forty-eight percent of subjects with FVL had adverse outcomes while in the group of subjects with no FVL, adverse outcomes occurred at a frequency of 37%. Conclusions Known mutations and novel SNPs in the factor V gene were identified in the study cohort determined to have APCR in pregnancy. Further studies are required to investigate the contribution of these novel SNPs to the APCR phenotype. Adverse outcomes including early pregnancy loss (EPL), preeclampsia (PET) and intrauterine growth restriction (IGUR) were not significantly more

  20. Practices for predicting and preventing preterm birth in Ireland: a national survey.

    LENUS (Irish Health Repository)

    Smith, V

    2011-03-01

    Preterm birth can result in adverse outcomes for the neonate and\\/or his\\/her family. The accurate prediction and prevention of preterm birth is paramount. This study describes and critically analyses practices for predicting and preventing preterm birth in Ireland.

  1. A prospective study to assess role of serum lactate dehydrogenase in prediction of adverse outcomes of pre-eclampsia and eclampsia

    Directory of Open Access Journals (Sweden)

    Jyoti Jharia

    2016-08-01

    Results: Higher grades of proteinuria, higher BP and serum LDH levels >600 IU/L are significantly associated with adverse maternal and fetal outcome. Conclusions: LDH co-relates with adversity of maternal and fetal outcome in eclampsia and pre-eclampsia. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000: 2522-2529

  2. Risk of adverse pregnancy outcomes in women with periodontal disease and the effectiveness of interventions in decreasing this risk: Protocol for systematic overview of systematic reviews

    NARCIS (Netherlands)

    S.F. Vanterpool (Sizzle); K. Tomsin (Kathleen); L. Reyes (Leticia); L.J.I. Zimmermann (Luc); B.W. Kramer (Boris); J.V. Been (Jasper V.)

    2016-01-01

    textabstractBackground: Periodontal disease is an inflammatory disease of the tissues supporting the teeth. Women who have periodontal disease while pregnant may be at risk of adverse pregnancy outcomes. Although the association between periodontal disease and adverse pregnancy outcomes has been add

  3. The Medtronic Sprint Fidelis Lead Advisory Notification has no adverse impact on patient reported outcomes in Danish implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne Møller; Versteeg, Henneke; Nielsen, Jens C.;

    The Medtronic Sprint Fidelis Lead Advisory Notification has no adverse impact on patient reported outcomes in Danish implantable cardioverter defibrillator patients.......The Medtronic Sprint Fidelis Lead Advisory Notification has no adverse impact on patient reported outcomes in Danish implantable cardioverter defibrillator patients....

  4. The Medtronic Sprint Fidelis Lead Advisory Notification Has No Adverse Impact on Patient Reported Outcomes in Danish Implantable Cardioverter Defibrillator Patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne Møller; Versteeg, Henneke; Nielsen, Jens C.;

    The Medtronic Sprint Fidelis Lead Advisory Notification Has No Adverse Impact on Patient Reported Outcomes in Danish Implantable Cardioverter Defibrillator Patients.......The Medtronic Sprint Fidelis Lead Advisory Notification Has No Adverse Impact on Patient Reported Outcomes in Danish Implantable Cardioverter Defibrillator Patients....

  5. The Outcomes of Very Early Preterm Births in the Republic of Sakha (Yakutia

    Directory of Open Access Journals (Sweden)

    Nyurguyana S. Baisheva

    2016-03-01

    Full Text Available Protection of maternal and child health is a special health care industry. It largely determines the future of the nation. Therefore, it is an important matter of the state. This article presents an analysis of cases of very early preterm births (VEPB and their outcomes in 2012-2014 in the Republic of Sakha (Yakutia (RS (Y. Retrospective analysis of the cases of VEPB and of the status of health of the babies born before 28 weeks of gestation was conducted during the research. The group at risk of VEPB consisted of women with burdened obstetric and gynecological history. The main causes of VEPB were premature amniorrhexis in pregnant women with carriage of infections and life-threatening severe pre-eclampsia. In the structure of morbidity of very preterm babies the first place among the main diseases belongs to perinatal lesion of CNS, the second place belongs to respiratory distress syndrome, and the third place to infectious and inflammatory diseases. In the structure of death, 57.1 % of fatal cases are babies with a term of gestation less than 28 weeks. The causes of mortality were respiratory distress syndrome, congenital pneumonia, and intraventricular hemorrhage.

  6. Systems Toxicology of Male Reproductive Development: Profiling 774 Chemicals for Molecular Targets and Adverse Outcomes

    Science.gov (United States)

    Adverse trends in male reproductive health have been reported for increased rates of testicular germ cell tumor, low semen quality, cryptorchidism, and hypospadias. An association with prenatal environmental exposure has been inferred from human and animal studies underlying male...

  7. Peri-conceptional A1C and risk of serious adverse pregnancy outcome in 933 women with type 1 diabetes

    DEFF Research Database (Denmark)

    Jensen, Dorte M; Korsholm, Lars; Ovesen, Per;

    2009-01-01

    OBJECTIVE: To study the association between peri-conceptional A1C and serious adverse pregnancy outcome (congenital malformations and perinatal mortality). RESEARCH DESIGN AND METHODS: Prospective data were collected in 933 singleton pregnancies complicated by type 1 diabetes. RESULTS: The risk...... of serious adverse outcome at different A1C levels was compared with the background population. The risk was significantly higher when peri-conceptional A1C exceeded 6.9%, and the risk tended to increase gradually with increasing A1C. Women with A1C exceeding 10.4% had a very high risk of 16%. Congenital...... malformation rate increased significantly at A1C above 10.4%, whereas perinatal mortality was increased even at A1C below 6.9%. CONCLUSIONS: These results support recent guidelines of preconceptional A1C levels

  8. Adverse pregnancy outcomes in offspring of fathers working in biomedical research laboratories

    DEFF Research Database (Denmark)

    Magnusson, Linda L; Bodin, Lennart; Wennborg, Helena

    2006-01-01

    of male employees in biomedical research laboratories are examined. METHODS: Offspring to males employed 1970-1989 at four Swedish universities were identified via the Medical Birth Register (MBR), along with other pregnancy parameters. Offspring of fathers with laboratory work (n = 2,281) is considered...

  9. Establishment of Exposure-response Functions of Air Particulate Matter and Adverse Health Outcomes in China and Worldwide

    Institute of Scientific and Technical Information of China (English)

    HAI-DONG KAN; BING-HENG CHEN; CHANG-HONG CHEN; BING-YAN WANG; QING-YAN FU

    2005-01-01

    Objective To obtain the exposure-response functions that could be used in health-based risk assessment of particulate air pollution in China. Methods Meta analysis was conducted on the literatures on air particulate matter and its adverse health outcomes in China and worldwide. Results For each health outcome from morbidity to mortality changes, the relative risks were estimated when the concentration of air particulate matter increased to some certain units. Conclusion The exposure-response functions recommended here can be further applied to health risk assessment of air particulate matter in China.

  10. Adverse mental health outcomes associated with emotional abuse in young rural South African women: a cross-sectional study

    OpenAIRE

    Jina, Ruxana; Jewkes, Rachel; Hoffman, Susie; Dunkle, Kristen L.; Nduna, Mzikazi; Shai, Nwabisa J.

    2011-01-01

    There is a lack of data on the prevalence of emotional abuse in youth. The aim of this study was thus to estimate the prevalence of emotional abuse in intimate partnerships among young women in rural South Africa and to measure the association between lifetime experience of emotional abuse (with and without the combined experience of physical and/or sexual abuse) and adverse health outcomes. Between 2002 and 2003, young women from 70 villages were recruited to participate in the cluster rando...

  11. Long-term adverse outcomes in survivors of childhood bone sarcoma: the British Childhood Cancer Survivor Study

    OpenAIRE

    Fidler, M M; Frobisher, C; Guha, J; K. Wong; Kelly, J; Winter, D. L.; Sugden, E; Duncan, R.; Whelan, J; Reulen, R C; Hawkins, M. M.

    2015-01-01

    Background: With improved survival, more bone sarcoma survivors are approaching middle age making it crucial to investigate the late effects of their cancer and its treatment. We investigated the long-term risks of adverse outcomes among 5-year bone sarcoma survivors within the British Childhood Cancer Survivor Study. Methods: Cause-specific mortality and risk of subsequent primary neoplasms (SPNs) were investigated for 664 bone sarcoma survivors. Use of health services, health and marital st...

  12. Planned home birth: benefits, risks, and opportunities.

    Science.gov (United States)

    Zielinski, Ruth; Ackerson, Kelly; Kane Low, Lisa

    2015-01-01

    While the number of women in developed countries who plan a home birth is low, the number has increased over the past decade in the US, and there is evidence that more women would choose this option if it were readily available. Rates of planned home birth range from 0.1% in Sweden to 20% in the Netherlands, where home birth has always been an integrated part of the maternity system. Benefits of planned home birth include lower rates of maternal morbidity, such as postpartum hemorrhage, and perineal lacerations, and lower rates of interventions such as episiotomy, instrumental vaginal birth, and cesarean birth. Women who have a planned home birth have high rates of satisfaction related to home being a more comfortable environment and feeling more in control of the experience. While maternal outcomes related to planned birth at home have been consistently positive within the literature, reported neonatal outcomes during planned home birth are more variable. While the majority of investigations of planned home birth compared with hospital birth have found no difference in intrapartum fetal deaths, neonatal deaths, low Apgar scores, or admission to the neonatal intensive care unit, there have been reports in the US, as well as a meta-analysis, that indicated more adverse neonatal outcomes associated with home birth. There are multiple challenges associated with research designs focused on planned home birth, in part because conducting randomized controlled trials is not feasible. This report will review current research studies published between 2004 and 2014 related to maternal and neonatal outcomes of planned home birth, and discuss strengths, limitations, and opportunities regarding planned home birth. PMID:25914559

  13. Levels and Correlates of Non-Adherence to WHO Recommended Inter-Birth Intervals in Rufiji, Tanzania.

    OpenAIRE

    Exavery Amon; Mrema Sigilbert; Shamte Amri; Bietsch Kristin; Mosha Dominic; Mbaruku Godfrey; Masanja Honorati

    2012-01-01

    Abstract Background Poorly spaced pregnancies have been documented worldwide to result in adverse maternal and child health outcomes. The World Health Organization (WHO) recommends a minimum inter-birth interval of 33 months between two consecutive live births in order to reduce the risk of adverse maternal and child health outcomes. However, birth spacing practices in many developing countries, including Tanzania, remain scantly addressed. Methods Longitudinal data collected in the Rufiji He...

  14. Parental urinary biomarkers of preconception exposure to bisphenol A and phthalates in relation to birth outcomes

    OpenAIRE

    Smarr, Melissa M.; Grantz, Katherine L.; Sundaram, Rajeshwari; Maisog, José M.; Kannan, Kurunthachalam; Louis, Germaine M. Buck

    2015-01-01

    Background Bisphenol A (BPA) and phthalates are ubiquitous non-persistent endocrine disrupting chemicals whose relation with infant birth size is not clearly understood. Methods We examined associations between maternal and paternal preconception urinary concentrations of total BPA and 14 phthalate metabolites and birth size for 233 infants. Multiple linear regression models were used to estimate parental quartiles of BPA and phthalates in relation to birth weight, length, head circumference,...

  15. Birth outcome in women with ulcerative colitis and Crohn's disease, and pharmacoepidemiological aspects of anti-inflammatory drug therapy

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz

    2011-01-01

    prescription Database, the Danish National Hospital Discharge Registry, the Danish Medical Birth Registry, and review of selected medical records. After exposure to sulfasalazine during pregnancy our data suggest. No significantly increased overall relative risk of congenital abnormalities and no significantly...... with similar underlying diseases. It is difficult to rule out an influence of uncontrolled confounding. These were the first published data from a controlled observational study on exposed women with chronic inflammatory bowel disease. After preconceptional paternal use of azathioprine/6-mercaptopurine our...... National Hospital Discharge Registry, the nationwide Danish Prescription Database and the Danish Medical Birth Registry. Furthermore, birth outcomes are examined in Crohn's disease women with disease activity during pregnancy, based on data from review of hospital records, the Danish National Hospital...

  16. Neonatal outcomes among multiple births ≤ 32 weeks gestational age: Does mode of conception have an impact? A Cohort Study

    Directory of Open Access Journals (Sweden)

    Yoon Woojin

    2011-06-01

    Full Text Available Abstract Background Studies comparing perinatal outcomes in multiples conceived following the use of artificial reproductive technologies (ART vs. spontaneous conception (SC have reported conflicting results in terms of mortality and morbidity. Therefore, the objective of our study was to compare composite outcome of mortality and severe neonatal morbidities amongst preterm multiple births ≤ 32 weeks gestation infant born following ART vs. SC. Methods We conducted a single center cohort study at Mount Sinai Hospital, Toronto, Ontario, Canada. Data on all preterm multiple births (≤ 32 weeks GA discharged between July 2005 and June 2008 were retrospectively collected from a prospective database at our centre. Details regarding mode of conception were collected retrospectively from maternal health records. Preterm multiple births were categorized into those born following ART vs. SC. Composite outcome was defined as combination of death or any of the three neonatal morbidities (grade 3/4 intraventricular hemorrhage or periventricular leukomalacia; retinopathy of prematurity > stage 2 or chronic lung disease. Univariate and multivariate regression analysis were preformed after adjustment of confounders (maternal age, parity, triplets, gestational age, sex, and small for gestational age. Results One hundred and thirty seven neonates were born following use of ART and 233 following SC. The unadjusted composite outcome rate was significantly higher in preterm multiples born following ART vs. SC [43.1% vs. 26.6%, p = 0.001; OR 1.98 (95% CI 1.13, 3.45]; however, when adjusted for confounders the difference between groups was not statistically significant [OR 1.39, 95% CI 0.67, 2.89]. Conclusion In our population of preterm multiple births, the mode of conception had no detectable effect on the adjusted composite neonatal outcome of mortality and/or three neonatal morbidities.

  17. Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis.

    Science.gov (United States)

    Rahman, M M; Abe, S K; Kanda, M; Narita, S; Rahman, M S; Bilano, V; Ota, E; Gilmour, S; Shibuya, K

    2015-09-01

    We conducted a systematic review and meta-analysis of population-based cohort studies of maternal body mass index (BMI) and risk of adverse birth and health outcomes in low- and middle-income countries. PubMed, Embase, CINAHL and the British Nursing Index were searched from inception to February 2014. Forty-two studies were included. Our study found that maternal underweight was significantly associated with higher risk of preterm birth (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27), low birthweight (OR, 1.66; 95% CI, 1.50-1.84) and small for gestational age (OR, 1.85; 95% CI, 1.69-2.02). Compared with mothers with normal BMI, overweight or obese mothers were at increased odds of gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, caesarean delivery and post-partum haemorrhage. The population-attributable risk (PAR) indicated that if women were entirely unexposed to overweight or obesity during the pre-pregnancy or early pregnancy period, 14% to 35% fewer women would develop gestational diabetes, pre-eclampsia or pregnancy-induced hypertension in Brazil, China, India, Iran or Thailand. The highest PAR of low birthweight attributable to maternal underweight was found in Iran (20%), followed by India (18%), Thailand (10%) and China (8%). Treatment and prevention of maternal underweight, overweight or obesity may help reduce the burden on maternal and child health in developing countries. PMID:26094567

  18. Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis.

    Science.gov (United States)

    Rahman, M M; Abe, S K; Kanda, M; Narita, S; Rahman, M S; Bilano, V; Ota, E; Gilmour, S; Shibuya, K

    2015-09-01

    We conducted a systematic review and meta-analysis of population-based cohort studies of maternal body mass index (BMI) and risk of adverse birth and health outcomes in low- and middle-income countries. PubMed, Embase, CINAHL and the British Nursing Index were searched from inception to February 2014. Forty-two studies were included. Our study found that maternal underweight was significantly associated with higher risk of preterm birth (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27), low birthweight (OR, 1.66; 95% CI, 1.50-1.84) and small for gestational age (OR, 1.85; 95% CI, 1.69-2.02). Compared with mothers with normal BMI, overweight or obese mothers were at increased odds of gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, caesarean delivery and post-partum haemorrhage. The population-attributable risk (PAR) indicated that if women were entirely unexposed to overweight or obesity during the pre-pregnancy or early pregnancy period, 14% to 35% fewer women would develop gestational diabetes, pre-eclampsia or pregnancy-induced hypertension in Brazil, China, India, Iran or Thailand. The highest PAR of low birthweight attributable to maternal underweight was found in Iran (20%), followed by India (18%), Thailand (10%) and China (8%). Treatment and prevention of maternal underweight, overweight or obesity may help reduce the burden on maternal and child health in developing countries.

  19. Maternal arsenic exposure and birth outcomes: A comprehensive review of the epidemiologic literature focused on drinking water

    Science.gov (United States)

    Bloom, Michael S.; Surdu, Simona; Neamtiu, Iulia A.; Gurzau, Eugen S.

    2015-01-01

    Inorganic arsenic (iAs) is a human toxicant to which populations may be exposed through consumption of geogenically contaminated groundwater. A growing body of experimental literature corroborates the reproductive toxicity of iAs; however, the results of human studies are inconsistent. Therefore, we conducted a comprehensive review of epidemiologic studies focused on drinking water iAs exposure and birth outcomes to assess the evidence for causality and to make recommendations for future study. We reviewed 18 English language papers assessing birth weight, gestational age, and birth size. Thirteen of the studies were conducted among populations with frequent exposure to high-level groundwater iAs contamination (>10 μg/L) and five studies were conducted in areas without recognized contamination. Most studies comprised small samples and used cross-sectional designs, often with ecologic exposure assessment strategies, although several large prospective investigations and studies with individual-level measurements were also reported. We conclude that: 1) the epidemiologic evidence for an increased risk of low birth weight (<2,500 grams) is insufficient, although there exists limited evidence for birth weight decreases; 2) the evidence for increased preterm delivery is insufficient; and, 3) there exists minimal evidence for decreased birth size. In further investigation of birth weight and size, we recommend incorporation of individual susceptibility measures using appropriate biomarkers, with collection timed to windows of vulnerability and speciated arsenic analysis, as well as consideration of populations exposed primarily to drinking water iAs contamination <10 μg/L. Given the large potential public health impact, additional, high quality epidemiologic studies are necessary to more definitively assess the risk. PMID:24713268

  20. CHARACTERIZATION OF THE MATERNAL AND NEONATAL ADVERSE OUTCOMES AFTER CAESAREAN SECTION IN THE CLÍNICA DE MATERNIDAD RAFAEL CALVO

    Directory of Open Access Journals (Sweden)

    Rubio-Hoyos Sandra M

    2015-01-01

    Full Text Available Introduction: the World Health Organization (WHO recommends that the incidence of cesarean must not exceed 15%; however, its use has increased in the last two decades, which implies a public health problem. Objective: to characterize the maternal and neonatal adverse outcomes of caesarean in the Clínica Maternidad Rafael Calvo (CMRC,Cartagena-Colombia. Methodology: a descriptive cross-sectional study, where after cesarean maternal and neonatal adverse outcomes were characterized. Results: 1.804 cesarean sections (46.5% and 2.073 vaginal deliveries (53.5% were performed. The most common indications for cesarean section were before cesarean (35.5%, cephalo pelvic disproportion (30.6% and oligoamnios (10.8%. The most common adverse maternal outcomes were bleeding requiring transfusion (9.17%, surgical wound hematoma (3.28% and admission to ICU (1.5%. The most common adverse neonatal outcomes were APGAR <7 per minute (21.3%, transient tachypnea of the newborn (9.6% and Apgar <7 at 5 ‘(4.3%. Prenatal care (PNC was protective factor for uterine bleeding requiring transfusion (OR crude 0.54, CI 0.38 to 0.76, OR adjusted 0.53 IC 0.38 to 0.76, uterine bleeding which required hysterectomy (OR crude 0.20, CI 0.01 to 0.72, OR adjusted 0.11, IC: 0.11 to 0.72, obstetric shock (OR crude 0.06, IC: 0.00 to 0.55 ,OR adjusted 0.04, CI 0.04 to 0.38 and destination (rooming (OR 0.66, IC 0.49 to 0.90, APGAR <7 at 1 ‘( OR 0.78 IC 0.44 to 0.72, Apgar <7 at 5 ‘(adjusted OR 0.48, IC 0.28 to 0.82 and the presence of respiratory distress (OR crude 0,28 IC, 0.15 to 0.51; OR adjusted 0.53, IC 0.28 to 0.98 Conclusions: the proportion of cesarean sections performed in the CMRC (46.5% is above 15% recommended by WHO. Cesarean section leads to increased maternal and fetal morbidity. The CNP acted as a protective factor against the occurrence of adverse maternal and neonatal outcomes. Rev.cienc.biomed. 2015;6(2:241-250 KEYWORDS Cesarean; Obstetric; Hemorrhage.

  1. The Adverse Effect of Spasticity on 3-Month Poststroke Outcome Using a Population-Based Model

    OpenAIRE

    Belagaje, S. R.; C. Lindsell; Moomaw, C. J.; Alwell, K.; Flaherty, M. L.; Woo, D; Dunning, K; P. Khatri; Adeoye, O.; D. Kleindorfer; Broderick, J.; Kissela, B

    2014-01-01

    Several devices and medications have been used to address poststroke spasticity. Yet, spasticity's impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regression model for predicting 3-month modified Rankin Score (mRS) as an indicator of functional outcome. Here, we tested whether including spasticity improved model fit and estimated the effect spasticity had on the outcome. Spasticity was define...

  2. Methionine synthase reductase deficiency results in adverse reproductive outcomes and congenital heart defects in mice

    OpenAIRE

    Deng, Liyuan; Elmore, C. Lee; Lawrance, Andrea K.; Matthews, Rowena G.; Rozen, Rima

    2008-01-01

    Low dietary folate and polymorphisms in genes of folate metabolism can influence risk for pregnancy complications and birth defects. Methionine synthase reductase (MTRR) is required for activation of methionine synthase, a folate- and vitamin B12-dependent enzyme. A polymorphism in MTRR (p.I22M), present in the homozygous state in 25% of many populations, may increase risk for neural tube defects. To examine the impact of MTRR deficiency on early development and congenital heart defects, we u...

  3. Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes

    OpenAIRE

    Kurtz WS; Glueck CJ; Hutchins RK; Sisk RA; Wang P

    2016-01-01

    Will S Kurtz,1 Charles J Glueck,1 Robert K Hutchins,2,3 Robert A Sisk,2,3 Ping Wang1 1Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, 2Cincinnati Eye Institute, 3Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Background: Ocular vascular occlusion (OVO), first diagnosed during or immediately after giving birth, often reflects superposition of the physiologic thrombophilia of pregnancy on previously undiagnosed u...

  4. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-03-01

    To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI).

  5. Long-term follow-up of cognitive outcome after breech presentation at birth

    DEFF Research Database (Denmark)

    Sørensen, Henrik Toft; Steffensen, Flemming Hald; Olsen, Jørn;

    1999-01-01

    Studies of long-term consequences of birth in breech presentation are sparse. Therefore, we conducted a cohort study linking birth registry data with data collected during evaluation for military service in 4,298 conscripts born between 1973 and 1976. The cognitive functions were measured...

  6. Magnetic Resonance Imaging and Developmental Outcome Following Preterm Birth: Review of Current Evidence

    Science.gov (United States)

    Hart, Anthony R.; Whitby, Elspeth W.; Griffiths, Paul D.; Smith, Michael F.

    2008-01-01

    Preterm birth is associated with an increased risk of developmental difficulties. Magnetic resonance imaging (MRI) is increasingly being used to identify damage to the brain following preterm birth. It is hoped this information will aid prognostication and identify neonates who would benefit from early therapeutic intervention. Cystic…

  7. Study of correlation between placental morphology and adverse perinatal outcome in different conditions affecting pregnancy

    Directory of Open Access Journals (Sweden)

    Manik Sirpurkar

    2015-08-01

    Conclusions: These conditions also affect the perinatal outcome. Placental parameters are also altered along with foetal parameters like foetal weight. So the diagnosis of such risk factors in pregnancies during antenatal period will improve the outcome. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1165-1168

  8. Adverse outcome pathways (AOPs): A framework to support predictive toxicology (presentation)

    Science.gov (United States)

    High throughput and in silico methods are providing the regulatory toxicology community with capacity to rapidly and cost effectively generate data concerning a chemical’s ability to initiate one or more biological perturbations that may culminate in an adverse ecological o...

  9. Potential roles of omics data in the use of adverse outcome pathways for environmental risk assessment

    Science.gov (United States)

    The current approach to assessing adverse effects of chemicals in the environment is largely based on a battery of in-vivo study methods and a limited number of accepted in-silico approaches. For most substances the pool of data from which to predict ecosystem effects is limited ...

  10. Severe Adverse Maternal Outcomes among Women in Midwife-Led versus Obstetrician-Led Care at the Onset of Labour in the Netherlands: A Nationwide Cohort Study.

    Directory of Open Access Journals (Sweden)

    Ank de Jonge

    Full Text Available To test the hypothesis that it is possible to select a group of low risk women who can start labour in midwife-led care without having increased rates of severe adverse maternal outcomes compared to women who start labour in secondary care.We conducted a nationwide cohort study in the Netherlands, using data from 223 739 women with a singleton pregnancy between 37 and 42 weeks gestation without a previous caesarean section, with spontaneous onset of labour and a child in cephalic presentation. Information on all cases of severe acute maternal morbidity collected by the national study into ethnic determinants of maternal morbidity in the Netherlands (LEMMoN study, 1 August 2004 to 1 August 2006, was merged with data from the Netherlands Perinatal Registry of all births occurring during the same period. Our primary outcome was severe acute maternal morbidity (SAMM, i.e. admission to an intensive care unit, uterine rupture, eclampsia or severe HELLP, major obstetric haemorrhage, and other serious events. Secondary outcomes were postpartum haemorrhage and manual removal of placenta.Nulliparous and parous women who started labour in midwife-led care had lower rates of SAMM, postpartum haemorrhage and manual removal of placenta compared to women who started labour in secondary care. For SAMM the adjusted odds ratio's and 95% confidence intervals were for nulliparous women: 0.57 (0.45 to 0.71 and for parous women 0.47 (0.36 to 0.62.Our results suggest that it is possible to identify a group of women at low risk of obstetric complications who may benefit from midwife-led care. Women can be reassured that we found no evidence that midwife-led care at the onset of labour is unsafe for women in a maternity care system with a well developed risk selection and referral system.

  11. Adverse outcomes after major surgery in patients with pressure ulcer: a nationwide population-based retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Chia-Lun Chou

    Full Text Available Postoperative adverse outcomes in patients with pressure ulcer are not completely understood. This study evaluated the association between preoperative pressure ulcer and adverse events after major surgeries.Using reimbursement claims from Taiwan's National Health Insurance Research Database, we conducted a nationwide retrospective cohort study of 17391 patients with preoperative pressure ulcer receiving major surgery in 2008-2010. With a propensity score matching procedure, 17391 surgical patients without pressure ulcer were selected for comparison. Eight major surgical postoperative complications and 30-day postoperative mortality were evaluated among patients with pressure ulcer of varying severity.Patients with preoperative pressure ulcer had significantly higher risk than controls for postoperative adverse outcomes, including septicemia, pneumonia, stroke, urinary tract infection, and acute renal failure. Surgical patients with pressure ulcer had approximately 1.83-fold risk (95% confidence interval 1.54-2.18 of 30-day postoperative mortality compared with control group. The most significant postoperative mortality was found in those with serious pressure ulcer, such as pressure ulcer with local infection, cellulitis, wound or treatment by change dressing, hospitalized care, debridement or antibiotics. Prolonged hospital or intensive care unit stay and increased medical expenditures were also associated with preoperative pressure ulcer.This nationwide propensity score-matched retrospective cohort study showed increased postoperative complications and mortality in patients with preoperative pressure ulcer. Our findings suggest the urgency of preventing and managing preoperative pressure ulcer by a multidisciplinary medical team for this specific population.

  12. Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort

    DEFF Research Database (Denmark)

    Zeitlin, Jennifer; Draper, Elizabeth S; Kollée, Louis;

    2008-01-01

    and gender. RESULTS: Live births between 24 and 31 weeks of gestation were 9.9 per 1000 total live births with a range from 7.6 to 13.0 in the MOSAIC regions. Standardized mortality was doubled in high versus low mortality regions (18%-20% vs 7%-9%) and differed for infants gestation......OBJECTIVES: Advances in perinatal medicine increased survival after very preterm birth in all countries, but comparative population-based data on these births are not readily available. This analysis contrasts the rates and short-term outcome of live births before 32 weeks of gestation in 10...... of gestation without lethal congenital anomalies (N = 4908). Outcomes were rates of preterm birth, in-hospital mortality, intraventricular hemorrhage grades III and IV or cystic periventricular leukomalacia and bronchopulmonary dysplasia. Mortality and morbidity rates were standardized for gestational age...

  13. Self-reported parental exposure to pesticide during pregnancy and birth outcomes: the MecoExpo cohort study.

    Directory of Open Access Journals (Sweden)

    Flora Mayhoub

    Full Text Available The MecoExpo study was performed in the Picardy region of northern France, in order to investigate the putative relationship between parental exposures to pesticides (as reported by the mother on one hand and neonatal parameters on the other. The cohort comprised 993 mother-newborn pairs. Each mother completed a questionnaire that probed occupational, domestic, environmental and dietary sources of parental exposure to pesticides during her pregnancy. Multivariate regression analyses were then used to test for associations between the characteristics of parental pesticide exposure during pregnancy and the corresponding birth outcomes. Maternal occupational exposure was associated with an elevated risk of low birth weight (odds ratio (OR [95% confidence interval]: 4.2 [1.2, 15.4]. Paternal occupational exposure to pesticides was associated with a lower than average gestational age at birth (-0.7 weeks; p = 0.0002 and an elevated risk of prematurity (OR: 3.7 [1.4, 9.7]. Levels of domestic exposure to veterinary antiparasitics and to pesticides for indoor plants were both associated with a low birth weight (-70 g; p = 0.02 and -160 g; p = 0.005, respectively. Babies born to women living in urban areas had a lower birth length and a higher risk of low birth length (-0.4 cm, p = 0.006 and OR: 2.9 [1.5, 5.5], respectively. The present study results mainly demonstrate a negative correlation between fetal development on one hand and parental occupational and domestic exposure to pesticides on the other. Our study highlights the need to perform a global and detailed screening of all potential physiological effects when assessing in utero exposure to pesticides.

  14. The role of lupus nephritis in development of adverse maternal and fetal outcomes during pregnancy

    OpenAIRE

    Alimohammad Fatemi; Reyhaneh Motamedi Fard; Zahra Sayedbonakdar; Ziba Farajzadegan; Mina Saber

    2013-01-01

    Background: We aimed to investigate the relationship of lupus nephritis (LN) with fetal and maternal outcomes of pregnant patients with systemic lupus erythematosus (SLE). Methods: In a retrospective study, profiles of pregnant women with SLE were selected. Before pregnancy and at the end of first, second and third trimesters, SLE disease activity index-2K was assessed. Clinical and laboratory evaluations were carried out regularly. Maternal and fetal outcomes were recorded. Assessments o...

  15. Application of in silico and in vitro methods in the development of adverse outcome pathway constructs in wildlife.

    Science.gov (United States)

    Madden, Judith C; Rogiers, Vera; Vinken, Mathieu

    2014-11-19

    There is a long history of using both in silico and in vitro methods to predict adverse effects in humans and environmental species where toxicity data are lacking. Currently, there is a great deal of interest in applying these methods to the development of so-called 'adverse outcome pathway' (AOP) constructs. The AOP approach provides a framework for organizing information at the chemical and biological level, allowing evidence from both in silico and in vitro studies to be rationally combined to fill gaps in knowledge concerning toxicological events. Fundamental to this new paradigm is a greater understanding of the mechanisms of toxicity and, in particular, where these mechanisms may be conserved across taxa, such as between model animals and related wild species. This presents an opportunity to make predictions across diverse species, where empirical data are unlikely to become available as is the case for most species of wildlife.

  16. Biomarkers of effect in endocrine disruption: how to link a functional assay to an adverse outcome pathway

    Directory of Open Access Journals (Sweden)

    Stefano Lorenzetti

    2015-06-01

    Full Text Available The development of in vitro testing strategies may achieve a cost-effective generation of comprehensive datasets on a large number of chemicals, according to the requirements of the European Regulation REACH. Much emphasis is placed on in vitro methods based on subcellular mechanisms (e.g., nuclear receptor interaction, but it is necessary to define the predictive value of molecular or biochemical changes within an adverse outcome pathway (AOP. AOP pivots on the description of the flow from a molecular initiating event through a cascade of intermediate events needed to produce a specific adverse effect at organism level: downstream responses at cell level are, therefore, essential to define an AOP. Several in vitro assays are based on human cell lines representative of endocrine-targeted tissues (e.g., prostate and on functional biomarkers of clinical relevance (e.g., PSA secretion in human prostate epithelial cells. We discuss the implementation of such functional biomarkers in the AOP context.

  17. Protein Carbamylation in Chronic Systolic Heart Failure: Relation to Renal Impairment and Adverse Long-Term Outcomes

    Science.gov (United States)

    Wilson Tang, W. H.; Shrestha, Kevin; Wang, Zeneng; Borowski, Allen G.; Troughton, Richard W.; Klein, Allan L.; Hazen, Stanley L.

    2013-01-01

    Background Protein carbamylation, a post-translational modification promoted during uremia and catalyzed by myeloperoxidase (MPO) at sites of inflammation, is linked to altered protein structure, vascular dysfunction, and poor prognosis. We examine the relationship between plasma protein-bound homocitrulline (PBHCit) levels, a marker of protein lysine residue carbamylation, with cardio-renal function and long-term outcomes in chronic systolic heart failure. Methods and Results In 115 patients with chronic systolic HF (LVEF≤35%), we measured plasma PBHCit by quantitative mass spectrometry and performed comprehensive echocardiography with assessment of cardiac structure and performance. Adverse long-term events (death, cardiac transplant) were tracked for 5 years. In our study cohort, the median PBHCit level was 87 [IQR: 59, 128] μmol/mol Lysine. Higher plasma PBHcit levels were associated with poorer renal function (eGFR Spearman’s r= −0.37, p0.10 for each). Furthermore, elevated plasma PBHCit levels were not related to indices of cardiac structure or function (p>0.10 for all examined) except modestly with increased right atrial volume index (RAVi; r=0.31, p=0.002). PBHCit levels predicted adverse long-term events (Hazard ratio [HR]: 1.8, 95% CI 1.3– 2.6, p<0.001), including following adjustment for age, eGFR, MPO and NT-proBNP (HR: 1.9, 95% CI: 1.2–3.1, p=0.006). Conclusions In chronic systolic HF, protein carbamylation is associated with poorer renal but not cardiac function, and portends poorer long-term adverse clinical outcomes even when adjusted for cardio-renal indices of adverse prognosis. PMID:23582087

  18. MODELING BLACK-WHITE PRETERM BIRTH DISPARITY: ECOLOGIC AND MULTILEVEL MODELS

    Science.gov (United States)

    INTRODUCTION. The disparity between black and white women's adverse birth outcomes has been subject to much investigation, yet the factors underlying its persistence remain elusive, which has encouraged research on neighborhood-level influences. This work considers two main que...

  19. STUDY OF MATERNAL AND FETAL OUTCOME AND FACTORS AFFECTING SUCCESS WITH VAGINAL BIRTH AFTER CESAREAN SECTION IN TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Vijayasree

    2014-01-01

    Full Text Available Cesarean section must be justified only when benefits outweigh harm to the mother and fetus. The impact of Cesarean section on maternal and child health and its high cost compared with vaginal birth represent a public health problem. Cesarean section rate is increasing globally and reported to be 25 - 30% in recent studies . Several factors contribute to this increase , but repeat CS stands as the most relevant factor and contribute to about 29% of performed CS. One of the strategies proposed to reduce the CS rate is to increase the number of trials of labor among women who had previous one lower segment cesarean section. However , concern still remains r egarding associated maternal or neonatal complications and factors that lead to success or failure of VBAC. So , we undertook this study to evaluate the factors affecting success of VBAC. AIMS AND OBJECTIVE: To study maternal and fetal outcomes associated w ith trial of vaginal birth after cesarean section and to evaluate factors associated with its success. MATERIALS AND METHODS : It is an Observational prospective study performed on 100 partu rients in the department of OBG, in Mamata General Hospital , K hammam , Andhra Pradesh. Patients with previous one lower segment Cesarean section and a single fetus with cephalic presentation without cephalo - pelvic disproportion were included in the study. These women were given a trial for vaginal birth with observati on during labor by a partogram and external fetal cardiotocography. RESULTS: Vaginal birth was successful in 50%. Repeat Cesarean section was done in the other 50% due to suspicious scar (62% , fetal distress (24% and failure to progress (14%. Scar Ruptu re occurred in (6% , postpartum hemorrhage in (4% , neonatal incubation in (10% and the neonatal mortality was (2%. Vaginal birth was significantly higher in the age group 20 - 30 years , body mass index in between 20 - 25 , patients with prior vaginal birth , inter - pregnancy interval

  20. Maternal BMI Associations with Maternal and Cord Blood Vitamin D Levels in a North American Subset of Hyperglycemia and Adverse Pregnancy Outcome (HAPO Study Participants.

    Directory of Open Access Journals (Sweden)

    Jami L Josefson

    Full Text Available Obesity in pregnancy may be associated with reduced placental transfer of 25-hydroxyvitamin D (25-OHD. The objective of this study was to examine associations between maternal BMI and maternal and cord blood levels of 25-OHD in full term neonates born to a single racial cohort residing at similar latitude. Secondary objectives were to examine associations between maternal glucose tolerance with maternal levels of 25-OHD and the relationship between cord blood 25-OHD levels and neonatal size.This study was conducted among participants of the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO Study meeting the following criteria: residing at latitudes 41-43°, maternal white race, and gestational age 39-41 weeks. Healthy pregnant women underwent measures of height, weight, and a 75-g fasting oral glucose tolerance test (OGTT at approximately 28 weeks gestation. Maternal and cord blood sera were analyzed for total 25-OHD by HPLC tandem mass spectrometry. Statistical analyses included ANOVA and linear regression models.Maternal and cord blood (N = 360 mean levels (sd of 25-OHD were 37.2 (11.2 and 23.4 (9.2 ng/ml, respectively, and these levels were significantly different among the 3 field centers (ANOVA p< 0.001. Maternal serum 25-OHD was lower by 0.40 ng/ml for BMI higher by 1 kg/m2 (p<0.001 in an adjusted model. Maternal fasting plasma glucose, insulin sensitivity, and presence of GDM were not associated with maternal serum 25-OHD level when adjusted for maternal BMI. Cord blood 25-OHD was lower by 0.26 ng/ml for maternal BMI higher by 1 kg/m2 (p<0.004. With adjustment for maternal age, field center, birth season and maternal serum 25-OHD, the association of cord blood 25-OHD with maternal BMI was attenuated. Neither birth weight nor neonatal adiposity was significantly associated with cord blood 25-OHD levels.These results suggest that maternal levels of 25-OHD are associated with maternal BMI. The results also suggest that interpretation of

  1. Low Plasma alpha-Tocopherol Concentrations and Adverse Clinical Outcomes in Diabetic Hemodialysis Patients

    NARCIS (Netherlands)

    Espe, Katharina M.; Raila, Jens; Henze, Andrea; Blouin, Katja; Schneider, Andreas; Schmiedeke, Daniel; Krane, Vera; Pilz, Stefan; Schweigert, Florian J.; Hocher, Berthold; Wanner, Christoph; Drechsler, Christiane

    2013-01-01

    Background and objectives Trials with the antioxidant vitamin E have failed to show benefit in the general population. Considering the different causes of death in ESRD, this study investigated the association between plasma concentrations of alpha-tocopherol and specific clinical outcomes in diabet

  2. Parent-teacher disagreement regarding psychopathology in children : a risk factor for adverse outcome?

    NARCIS (Netherlands)

    Ferdinand, R. F.; van der Ende, J.; Verhulst, F. C.

    2007-01-01

    Objective: To investigate if parent-teacher discrepancies in reports of behavioral/emotional problems in children predict poor outcome. Method: A total of 1154 4- to 12-year-old children from the general population were followed up. At the first assessment, parent and teacher ratings were obtained w

  3. Adherence to medical treatment in relation to pregnancy, birth outcome & breastfeeding behavior among women with Crohn's disease

    DEFF Research Database (Denmark)

    Julsgaard, Mette

    2016-01-01

    pregnancy outcomes, little is known about predictors for these outcomes in women with CD. In addition, the impact of breastfeeding on disease activity remains controversial. AIMS: The aims of this PhD thesis were to determine adherence to treatment and to investigate predictors for and prevalence rates...... of non-adherence to maintenance medical treatment among women with CD prior to, during, and after pregnancy; to assess pregnancy outcomes among women with CD, taking medical treatment, smoking status, and disease activity into account; to assess breastfeeding rates and the impact of breastfeeding...... on the risk of relapse. METHODS: We conducted a population-based prevalence study including 154 women with CD who had given birth within a six-year period. We combined questionnaire data, data from medical records, and medical register data. RESULTS: Among 105 (80%) respondents, more than half reported taking...

  4. Household and community-level Adverse Childhood Experiences and adult health outcomes in a diverse urban population.

    Science.gov (United States)

    Wade, Roy; Cronholm, Peter F; Fein, Joel A; Forke, Christine M; Davis, Martha B; Harkins-Schwarz, Mary; Pachter, Lee M; Bair-Merritt, Megan H

    2016-02-01

    Adverse Childhood Experiences (ACEs), which include family dysfunction and community-level stressors, negatively impact the health and well being of children throughout the life course. While several studies have examined the impact of these childhood exposures amongst racially and socially diverse populations, the contribution of ACEs in the persistence of socioeconomic disparities in health is poorly understood. To determine the association between ACEs and health outcomes amongst a sample of adults living in Philadelphia and examine the moderating effect of Socioeconomic Status (SES) on this association, we conducted a cross-sectional survey of 1,784 Philadelphia adults, ages 18 and older, using random digit dialing methodology to assess Conventional ACEs (experiences related to family dysfunction), Expanded ACEs (community-level stressors), and health outcomes. Using weighted, multivariable logistic regression analyses along with SES stratified models, we examined the relationship between ACEs and health outcomes as well as the modifying effect of current SES. High Conventional ACE scores were significantly associated with health risk behaviors, physical and mental illness, while elevated Expanded ACE scores were associated only with substance abuse history and sexually transmitted infections. ACEs did have some differential impacts on health outcomes based on SES. Given the robust impact of Conventional ACEs on health, our results support prior research highlighting the primacy of family relationships on a child's life course trajectory and the importance of interventions designed to support families. Our findings related to the modifying effect of SES may provide additional insight into the complex relationship between poverty and childhood adversity. PMID:26726759

  5. PM2.5与不良妊娠结局%The Association of PM2.5 with Adverse Pregnancy Outcomes

    Institute of Scientific and Technical Information of China (English)

    吴思雨; 侯海燕; 陈娟; 陈亚琼; 江静

    2016-01-01

    Through the review of nearly 40 domestic and foreign literature, the formation, components and toxicity of PM2.5 and its association with adverse birth outcomes (ABOs) including low birth weight (LBW), preterm birth (PTB), stillbirth, gestational diabetes mellitus (GDM) and pre-eclampsia are investigated. PM2.5 mainly consists of element carbon, organic carbon, inorganic matter and heavy metals. Coal burning and traffic are the main sources of urban PM2.5. Heavy metals and polycyclic aromatic hydrocarbons were the main toxic components of PM2.5, which could exert adverse effect on pregnancy outcome through direct placental permeation, affecting maternal endocrine and immune system, inducing oxidative stress or changing genetic materials. At last, there is still mystery about the association of PM2.5 and GDM and pre-eclampsia. Nevertheless, PM2.5 is convincingly thought to be a risk factor of LBW, PTB and stillbirth.%通过回顾近40篇中外文献,介绍PM2.5的基本成因及组成,阐述PM2.5的毒理学研究结果及其与不良妊娠结局的关系,包括PM2.5与低出生体质量(LBW)、早产(PTB)、胚胎停育、妊娠期糖尿病(GDM)及子痫前期的关系。发现PM2.5化学成分主要包括元素碳、有机碳、无机成分和微量重金属元素。燃煤和交通均是城市PM2.5的主要来源。重金属和多环芳烃类物质是PM2.5的主要毒性组分,母体吸入PM2.5后,吸附在颗粒物上的毒性物质可通过胎盘直接渗透,影响母体的内分泌及免疫系统,引起氧化应激、遗传物质改变,对胚胎或胎儿造成影响。推测PM2.5是低出生体质量、早产及胚胎停育的危险因素;但PM2.5是否是GDM、子痫前期的危险因素仍有待研究。

  6. OUTCOME OF CHILDREN AT 1-2 YEARS AND MATERNAL MORB IDITY AFTER CESAREAN SECTION VS VAGINAL BIRTH FOR BREECH PRESENTATION AT OR NEAR TERM

    Directory of Open Access Journals (Sweden)

    Jyoti Ramesh

    2013-02-01

    Full Text Available ABSTRACT: Back ground: In 2000 an international multicentric randomized co ntrol trial of planned vaginal delivery vs planned elective caesarea n section for uncomplicated term breech presentation confirmed that perinatal mortality and s erious neonatal morbidity were significantly lower in planned caesarean group. Seco ndary analysis of Term Breech Trial showed that prelabour caesarean and caesarean during early labour were associated with lowest adverse perinatal outcome due to labour or de livery and that vaginal delivery had the highest risk of adverse outcome AIMS: The purpose of this study is to determine the outco me of children at 1-2 years and maternal morbidity after caesarean section vs. vaginal birth for breech presentation at or near term. SETTINGS AND DESIGN: Prospective observational study from 1 st January 2008-30 th June 2009( 18 months at Institute of Maternal & Child Health , Govt. Medical College Kozhikode. METHODS AND MATERIAL: Outcome of 45 assisted breech deliveries during this period analyzed from case rec ords. 90 Cesarean deliveries during the same period randomly selected as control. STATISTICAL ANALYSIS USED: Data analyzed using SPSS version 16.0.Chi square test was used to compare the outcome. A p value <0.05 was considered to indicate statistical significance. RESULTS : Vaginal delivery group- Five minute Apgar <7 (p=0.019, NICU admission (p=0.00001(RR 4.71 , 95% CI 2.33 to 9.91,Neonatal morbidity (p=0.012RR 2.627,95% CI 1.216 to 5.678 , Prolonged hospitalisation (p=0.005 RR = 2.962 ,95% CI 1.354 to 6.478 statistically signific ant in vaginal delivery group .Caesarean Section group-Elective 30(33.3% Emergency 60(66.6% Neonatal complication( p=0.03 RR=2.57 ,95% CI 1.06 to 6.2, NICU admission ( p=0.01 3 RR=2.86 ,95% CI 1.21 to 6.76. were statistically significant in elective section grou p Maternal morbidity was not associated with type of CS p=0.2 RR = 1.39 ,95% CI 0.447 to 4.307. However the perinatal mortality was

  7. Do studies reporting ‘U’-shaped serum 25-hydroxyvitamin D–health outcome relationships reflect adverse effects?

    Science.gov (United States)

    Grant, William B.; Karras, Spyridon N.; Bischoff-Ferrari, Heike A.; Annweiler, Cedric; Boucher, Barbara J.; Juzeniene, Asta; Garland, Cedric F.; Holick, Michael F.

    2016-01-01

    ABSTRACT Several reports describe U-shaped 25-hydroxyvitamin D [25(OH)D] concentration–health outcomes, including musculo-skeletal disorders such as falls and fractures, several cancers, cardiovascular disease (CVD), cognitive function, all-cause mortality rates, birth outcomes, allergic reactions, frailty, and some other disorders. This paper reviews reports of U-shaped outcome associations with vitamin D status for evidence of underlying pathophysiological processes, or of confounding, finding that some U-shaped associations appear to be biologically meaningful, but that many could well reflect confounding by factors such as lifestyle, or hypovitaminosis D-related disease onset being masked by self-supplementation that was begun too late to correct developing health problems but before baseline vitamin D status assessment. However, the various U-shaped associations for allergic reactions may be due to vitamin D modulation of the phenotype of the immune response, shifting the Th1-Th2 balance toward Th2 formation. For prostate cancer, there seems to be little effect of 25(OH)D concentration on incidence; however, there is an inverse correlation between 25(OH)D concentration and mortality rates. Future observational studies, and randomized controlled trial data analyses, should include adjustment for data collected on prior long-term vitamin D supplementation and solar UVB exposure, as well as other potential confounders. PMID:27489574

  8. Do studies reporting 'U'-shaped serum 25-hydroxyvitamin D-health outcome relationships reflect adverse effects?

    Science.gov (United States)

    Grant, William B; Karras, Spyridon N; Bischoff-Ferrari, Heike A; Annweiler, Cedric; Boucher, Barbara J; Juzeniene, Asta; Garland, Cedric F; Holick, Michael F

    2016-01-01

    Several reports describe U-shaped 25-hydroxyvitamin D [25(OH)D] concentration-health outcomes, including musculo-skeletal disorders such as falls and fractures, several cancers, cardiovascular disease (CVD), cognitive function, all-cause mortality rates, birth outcomes, allergic reactions, frailty, and some other disorders. This paper reviews reports of U-shaped outcome associations with vitamin D status for evidence of underlying pathophysiological processes, or of confounding, finding that some U-shaped associations appear to be biologically meaningful, but that many could well reflect confounding by factors such as lifestyle, or hypovitaminosis D-related disease onset being masked by self-supplementation that was begun too late to correct developing health problems but before baseline vitamin D status assessment. However, the various U-shaped associations for allergic reactions may be due to vitamin D modulation of the phenotype of the immune response, shifting the Th1-Th2 balance toward Th2 formation. For prostate cancer, there seems to be little effect of 25(OH)D concentration on incidence; however, there is an inverse correlation between 25(OH)D concentration and mortality rates. Future observational studies, and randomized controlled trial data analyses, should include adjustment for data collected on prior long-term vitamin D supplementation and solar UVB exposure, as well as other potential confounders. PMID:27489574

  9. Association between nutritional risk and routine clinical laboratory measurements and adverse outcomes: a prospective study in hospitalized patients of wuhan tongji hospital

    OpenAIRE

    Chen, Z. Y.; Gao, C.; Ye, T; Zuo, X Z; G. H. Wang; Xu, X. S.; Yao, Y

    2014-01-01

    Background/Objectives: Nutritional risk screening (NRS-2002) and routine clinical laboratory measurements (RCLMs) had been shown to have a predictive value in adverse outcomes in some studies, respectively. This study analyzed the association between NRS-2002 and RCLMs and estimated their prospective value in predicting adverse outcomes. Subjects/Methods: A total of 916 hospitalized patients were screened on admission with NRS-2002 and Subjective Global Assessment; RCLMs, which include blood ...

  10. Maternal Prenatal Positive Affect, Depressive and Anxiety Symptoms and Birth Outcomes: The PREDO Study.

    Directory of Open Access Journals (Sweden)

    Anu-Katriina Pesonen

    Full Text Available We investigated whether maternal prenatal emotions are associated with gestational length and birth weight in the large PREDO Study with multiple measurement points of emotions during gestation.Altogether 3376 pregnant women self-assessed their positive affect (PA, Positive and Negative Affect Schedule and depressive (Center for Epidemiologic Studies Depression Scale, CES-D and anxiety (Spielberger State Anxiety Scale, STAI symptoms up to 14 times during gestation. Birth characteristics were derived from the National Birth Register and from medical records.One standard deviation (SD unit higher PA during the third pregnancy trimester was associated with a 0.05 SD unit longer gestational length, whereas one SD unit higher CES-D and STAI scores during the third trimester were associated with 0.04-0.05 SD unit shorter gestational lengths (P-values ≤ 0.02, corresponding to only 0.1-0.2% of the variation in gestational length. Higher PA during the third trimester was associated with a significantly decreased risk for preterm (< 37 weeks delivery (for each SD unit higher positive affect, odds ratio was 0.8-fold (P = 0.02. Mothers with preterm delivery showed a decline in PA and an increase in CES-D and STAI during eight weeks prior to delivery. Post-term birth (≥ 42 weeks, birth weight and fetal growth were not associated with maternal prenatal emotions.This study with 14 measurements of maternal emotions during pregnancy show modest effects of prenatal emotions during the third pregnancy trimester, particularly in the weeks close to delivery, on gestational length. From the clinical perspective, the effects were negligible. No associations were detected between prenatal emotions and birth weight.

  11. Serum metabolomics identifies citrulline as a predictor of adverse outcomes in an equine model of gut-derived sepsis.

    Science.gov (United States)

    Steelman, Samantha M; Johnson, Philip; Jackson, Amy; Schulze, James; Chowdhary, Bhanu P

    2014-05-15

    Acute laminitis is an inflammatory disease of the equine foot that often occurs secondarily to sepsis or systemic inflammation associated with gastrointestinal disease. It has been suggested that laminitis is similar to multiple organ dysfunction syndrome in humans, although in horses the weight-bearing laminar epithelium of the foot appears to be the tissue most sensitive to insult and the first "organ" to fail. Metabolomics performed on serum samples collected before (Con) and after (Lmn) experimental induction of gastrointestinal-associated sepsis in six horses detected 1,177 metabolites of both mammalian and bacterial origin in equine serum. Network and correlation analyses suggested a dysregulation of fatty acid metabolism in the Lmn group, as well as an accumulation of organic acids such as lactate. Furthermore, concentrations of the amino acid citrulline were decreased in Lmn samples from all study animals, suggesting that citrulline might be useful as a biomarker to identify critically ill animals that are at risk of developing laminitis. We therefore established normal ranges of plasma citrulline concentrations in a separate group of horses (n = 36) and tested the ability of citrulline to predict adverse outcomes (laminitis or death) in critically ill horses (n = 23). Plasma citrulline was significantly lower in critically ill horses that went on to experience adverse outcomes (n = 6). Further study is required to accurately determine a diagnostic cutoff, but the present data are suggestive of the predictive value of citrulline as a biomarker for laminar failure in equine sepsis. PMID:24619519

  12. The effect of obesity on adverse outcomes and metabolism in pediatric burn patients

    OpenAIRE

    Kraft, Robert; Herndon, David N; Williams, Felicia N.; Al-Mousawi, Ahmed M.; Finnerty, Celeste C.; Jeschke, Marc G.

    2011-01-01

    Hypothesis Obesity influences metabolism and increases the incidence of clinical complications and worsens outcomes in pediatric burn patients. Design Retrospective, single-center study. Subjects Five hundred ninety-two severely burned pediatric patients who had burns covering more than 30% of the total body surface area and who were treated between 2001 and 2008 were enrolled in this study. Patients were divided into ≥ 85th percentile (n = 277) and normal (n = 315) weight groups based on bod...

  13. Adverse neurodevelopmental outcomes after exposure to phenobarbital and levetiracetam for the treatment of neonatal seizures

    OpenAIRE

    Maitre, Nathalie L.; Smolinsky, Ciaran; Slaughter, James C.; Stark, Ann R.

    2013-01-01

    Objective Compare neurodevelopment after levetiracetam (LEV) and phenobarbital (PB) for neonatal seizures. Study design Retrospective study of infants who received antiepileptic drugs (AEDs) for neonatal seizures. Effect of cumulative exposure to LEV and PB on outcomes of death, cerebral palsy (CP), and Bayley Scales of Infant Development (BSID) scores were evaluated at 24 months corrected age. Analyses were adjusted for number of electrographic seizures and gestational age. Results In 280 in...

  14. Is ABO blood group truly a risk factor for thrombosis and adverse outcomes?

    OpenAIRE

    Zhou, Shan; Welsby, Ian

    2014-01-01

    ABO blood type is one of the most readily available laboratory tests, and serves as a vital determinant in blood transfusion and organ transplantation. The ABO antigens are expressed not only on red blood cell membranes, determining the compatibility of transfusion, but also on the surface of other human cells, including epithelium, platelet and vascular endothelium, therefore extending the research into other involvements of cardiovascular disease and postoperative outcomes. ABO blood group ...

  15. Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes

    OpenAIRE

    Murphy, V E; Clifton, V.L.; Gibson, P G

    2006-01-01

    Exacerbations of asthma during pregnancy represent a significant clinical problem and may be related to poor pregnancy outcomes. A systematic review of the literature was conducted for publications related to exacerbations during pregnancy. Four studies with a control group (no asthma) and two groups of women with asthma (exacerbation, no exacerbation) were included in meta‐analyses using fixed effects models. During pregnancy, exacerbations of asthma which require medical intervention occur ...

  16. Elevated antiphospholipid antibody titers and adverse pregnancy outcomes: analysis of a population-based hospital dataset

    Directory of Open Access Journals (Sweden)

    Nuwayhid Bahij S

    2009-03-01

    Full Text Available Abstract Background The primary objective of this study was to determine if elevated antiphospholipid antibody titers were correlated with the presence of preeclampsia/eclampsia, systemic lupus erythematosus (SLE, placental insufficiency, and a prolonged length of stay (PLOS, in women who delivered throughout Florida, USA. Methods Cross-sectional analyses were conducted using a statewide hospital database. Prevalence odds ratios (OR were calculated to quantify the association between elevated antiphospholipid antibody titers and four outcomes in 141,286 women who delivered in Florida in 2001. The possibility that the relationship between elevated antiphospholipid antibody titers and the outcomes of preeclampsia/eclampsia, placental insufficiency, and PLOS, may have been modified by the presence of SLE was evaluated in a multiple logistic regression model by creating a composite interaction term. Results Women with elevated antiphospholipid antibody titers (n = 88 were older, more likely to be of white race and not on Medicaid than women who did not have elevated antiphospholipid antibody titers. Women who had elevated antiphospholipid antibody titers had an increased adjusted odds ratio for preeclampsia and eclampsia, (OR = 2.93 p = 0.0015, SLE (OR = 61.24 p Conclusion This exploratory epidemiologic investigation found moderate to very strong associations between elevated antiphospholipid antibody titers and four important outcomes in a large sample of women.

  17. Racial/Ethnic and nativity differences in birth outcomes among mothers in New York City: the role of social ties and social support.

    Science.gov (United States)

    Almeida, Joanna; Mulready-Ward, Candace; Bettegowda, Vani R; Ahluwalia, Indu B

    2014-01-01

    Immigrants have lower rates of low birth weight (LBW) and to some extent preterm birth (PTB), than their US-born counterparts. This pattern has been termed the 'immigrant health paradox'. Social ties and support are one proposed explanation for this phenomenon. We examined the contribution of social ties and social support to LBW and PTB by race/ethnicity and nativity among women in New York City (NYC). The NYC Pregnancy Risk Assessment Monitoring System survey (2004-2007) data, linked with the selected items from birth certificates, were used to examine LBW and PTB by race/ethnicity and nativity status and the role of social ties and social support to adverse birth outcomes using bivariate and multivariable analyses. SUDAAN software was used to adjust for complex survey design and sampling weights. US- and foreign-born Blacks had significantly increased odds of PTB [adjusted odds ratio (AOR) = 2.43, 95 % CI 1.56, 3.77 and AOR = 2.6, 95 % CI 1.66, 4.24, respectively] compared to US-born Whites. Odds of PTB among foreign-born Other Latinas, Island-born Puerto Ricans' and foreign-born Asians' were not significantly different from US-born Whites, while odds of PTB for foreign-born Whites were significantly lower (AOR = 0.47, 95 % CI 0.26, 0.84). US and foreign-born Blacks' odds of LBW were 2.5 fold that of US-born Whites. Fewer social ties were associated with 32-39 % lower odds of PTB. Lower social support was associated with decreased odds of LBW (AOR 0.69, 95 % CI 0.50, 0.96). We found stronger evidence of the immigrant health paradox across racial/ethnic groups for PTB than for LBW. Results also point to the importance of accurately assessing social ties and social support during pregnancy and to considering the potential downside of social ties.

  18. Depressive symptoms and adverse outcomes from hospitalization in older adults: secondary outcomes of a trial of falls prevention education.

    Science.gov (United States)

    Haines, Terry P; Williams, Cylie M; Hill, Anne-Marie; McPhail, Steven M; Hill, Keith D; Hill, D; Brauer, Sandy G; Hoffmann, Tammy C; Etherton-Beer, Chris

    2015-01-01

    Depression is common in older people and symptoms of depression are known to substantially increase during hospitalization. There is little known about predictors of depressive symptoms in older adults or impact of common interventions during hospitalization. This study aimed to describe the magnitude of depressive symptoms, shift of depressive symptoms and the impact of the symptoms of depression among older hospital patients during hospital admission and identify whether exposure to falls prevention education affected symptoms of depression. Participants (n=1206) were older adults admitted within two Australian hospitals, the majority of participants completed the Geriatric Depression Scale - Short Form (GDS) at admission (n=1168). Participants' mean age was 74.7 (±SD 11) years and 47% (n=551) were male. At admission 53% (619 out of 1168) of participants had symptoms of clinical depression and symptoms remained at the same level at discharge for 55% (543 out of 987). Those exposed to the low intensity education program had higher GDS scores at discharge than those in the control group (low intensity vs control n=652, adjusted regression coefficient (95% CI)=0.24 (0.02, 0.45), p=0.03). The only factor other than admission level of depression that affected depressive symptoms change was if the participant was worried about falling. Older patients frequently present with symptoms of clinical depression on admission to hospital. Future research should consider these factors, whether these are modifiable and whether treatment may influence outcomes.

  19. Initial Resuscitation at Delivery and Short Term Neonatal Outcomes in Very-Low-Birth-Weight Infants.

    Science.gov (United States)

    Cho, Su Jin; Shin, Jeonghee; Namgung, Ran

    2015-10-01

    Survival of very-low-birth-weight infants (VLBWI) depends on professional perinatal management that begins at delivery. Korean Neonatal Network data on neonatal resuscitation management and initial care of VLBWI of less than 33 weeks gestation born from January 2013 to June 2014 were reviewed to investigate the current practice of neonatal resuscitation in Korea. Antenatal data, perinatal data, and short-term morbidities were analyzed. Out of 2,132 neonates, 91.7% needed resuscitation at birth, chest compression was performed on only 104 infants (5.4%) and epinephrine was administered to 80 infants (4.1%). Infants who received cardiac compression and/or epinephrine administration at birth (DR-CPR) were significantly more acidotic (P periventricular leukomalacia (OR, 2.94; 95% CI 1.72-5.01), and necrotizing enterocolitis (OR, 2.12; 95% CI 1.15-3.91) compared with those infants who needed only PPV. Meticulous and aggressive management of infants who needed DR-CPR at birth and quality improvement of the delivery room management will result in reduced morbidities and early death for the vulnerable VLBWI. PMID:26566357

  20. Linking Assessment and Intervention for Developmental/Functional Outcomes of Premature, Low-Birth-Weight Children

    Science.gov (United States)

    Xu, Yaoying; Filler, John W.

    2005-01-01

    Prematurity and low birth weight (LBW) are two major biological factors that put infants and young children at high risk for developmental delays or disabilities. While survival rates for premature and LBW children have improved, incidence figures have changed little over the past 20 years; in fact, the incidence of LBW has increased. Although the…

  1. Cognitive and educational outcomes of being born small-for-gestational-age : A longitudinal study based on Stockholm Birth Cohort

    OpenAIRE

    Yu, Bing

    2016-01-01

    The aim of this study is to examine the long-term cognitive effects and educational outcomes of being born small-for-gestational-age (SGA). It also assesses whether the family’s attitude towards education modifies the effect of SGA on cognitive performance. A total of 9598 children born in 1953 and living in the Stockholm metropolitan area in 1963 were included in this study. Data were obtained from the Stockholm Birth Cohort. Multiple ordinary least square regressions analyses suggest that S...

  2. Long-Term Cognitive Outcomes of Birth Asphyxia and the Contribution of Identified Perinatal Asphyxia to Cerebral Palsy.

    Science.gov (United States)

    Pappas, Athina; Korzeniewski, Steven J

    2016-09-01

    Neonatal encephalopathy among survivors of presumed perinatal asphyxia is recognized as an important cause of cerebral palsy (CP) and neuromotor impairment. Recent studies suggest that moderate to severe neonatal encephalopathy contributes to a wide range of neurodevelopmental and cognitive impairments among survivors with and without CP. Nearly 1 of every 4 to 5 neonates treated with hypothermia has or develops CP. Neonatal encephalopathy is diagnosed in only approximately 10% of all cases. This article reviews the long-term cognitive outcomes of children with presumed birth asphyxia and describes what is known about its contribution to CP. PMID:27524454

  3. Adverse Outcomes After Palliative Radiation Therapy for Uncomplicated Spine Metastases: Role of Spinal Instability and Single-Fraction Radiation Therapy

    International Nuclear Information System (INIS)

    Purpose: Level I evidence demonstrates equivalent pain response after single-fraction (SF) or multifraction (MF) radiation therapy (RT) for bone metastases. The purpose of this study is to provide additional data to inform the incidence and predictors of adverse outcomes after RT for spine metastases. Methods and Materials: At a single institution, 299 uncomplicated spine metastases (without cord compression, prior RT, or surgery) treated with RT from 2008 to 2013 were retrospectively reviewed. The spinal instability neoplastic score (SINS) was used to assess spinal instability. The primary outcome was time to first spinal adverse event (SAE) at the site, including symptomatic vertebral fracture, hospitalization for site-related pain, salvage surgery, interventional procedure, new neurologic symptoms, or cord compression. Fine and Gray's multivariable model assessed associations of the primary outcome with SINS, SF RT, and other significant baseline factors. Propensity score matched analysis further assessed the relationship of SF RT to first SAEs. Results: The cumulative incidence of first SAE after SF RT (n=66) was 6.8% at 30 days, 16.9% at 90 days, and 23.6% at 180 days. For MF RT (n=233), the incidence was 3.5%, 6.4%, and 9.2%, respectively. In multivariable analysis, SF RT (hazard ratio [HR] = 2.8, 95% confidence interval [CI] 1.5-5.2, P=.001) and SINS ≥11 (HR=2.5 , 95% CI 1.3-4.9, P=.007) were predictors of the incidence of first SAE. In propensity score matched analysis, first SAEs had developed in 22% of patients with SF RT versus 6% of those with MF RT cases (HR=3.9, 95% CI 1.6-9.6, P=.003) at 90 days after RT. Conclusion: In uncomplicated spinal metastases treated with RT alone, spinal instability with SINS ≥11 and SF RT were associated with a higher rate of SAEs

  4. Adverse Outcomes After Palliative Radiation Therapy for Uncomplicated Spine Metastases: Role of Spinal Instability and Single-Fraction Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lam, Tai-Chung, E-mail: lamtaichung@gmail.com [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Uno, Hajime [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Krishnan, Monica [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Lutz, Steven [Department of Radiation Oncology, Blanchard Valley Regional Medical Center, Findlay, Ohio (United States); Groff, Michael [Department of Neurosurgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Cheney, Matthew [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Balboni, Tracy [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2015-10-01

    Purpose: Level I evidence demonstrates equivalent pain response after single-fraction (SF) or multifraction (MF) radiation therapy (RT) for bone metastases. The purpose of this study is to provide additional data to inform the incidence and predictors of adverse outcomes after RT for spine metastases. Methods and Materials: At a single institution, 299 uncomplicated spine metastases (without cord compression, prior RT, or surgery) treated with RT from 2008 to 2013 were retrospectively reviewed. The spinal instability neoplastic score (SINS) was used to assess spinal instability. The primary outcome was time to first spinal adverse event (SAE) at the site, including symptomatic vertebral fracture, hospitalization for site-related pain, salvage surgery, interventional procedure, new neurologic symptoms, or cord compression. Fine and Gray's multivariable model assessed associations of the primary outcome with SINS, SF RT, and other significant baseline factors. Propensity score matched analysis further assessed the relationship of SF RT to first SAEs. Results: The cumulative incidence of first SAE after SF RT (n=66) was 6.8% at 30 days, 16.9% at 90 days, and 23.6% at 180 days. For MF RT (n=233), the incidence was 3.5%, 6.4%, and 9.2%, respectively. In multivariable analysis, SF RT (hazard ratio [HR] = 2.8, 95% confidence interval [CI] 1.5-5.2, P=.001) and SINS ≥11 (HR=2.5 , 95% CI 1.3-4.9, P=.007) were predictors of the incidence of first SAE. In propensity score matched analysis, first SAEs had developed in 22% of patients with SF RT versus 6% of those with MF RT cases (HR=3.9, 95% CI 1.6-9.6, P=.003) at 90 days after RT. Conclusion: In uncomplicated spinal metastases treated with RT alone, spinal instability with SINS ≥11 and SF RT were associated with a higher rate of SAEs.

  5. Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis.

    Science.gov (United States)

    Srihawan, Chanunya; Castelblanco, Rodrigo Lopez; Salazar, Lucrecia; Wootton, Susan H; Aguilera, Elizabeth; Ostrosky-Zeichner, Luis; Sandberg, David I; Choi, HuiMahn A; Lee, Kiwon; Kitigawa, Ryan; Tandon, Nitin; Hasbun, Rodrigo

    2016-04-01

    Background.  Healthcare-associated meningitis or ventriculitis is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Methods.  We performed a retrospective study of adults and children with the diagnosis of healthcare-associated meningitis or ventriculitis, as defined by the 2015 Centers of Disease Control and Prevention case definition, at 2 large tertiary care hospitals in Houston, Texas from July 2003 to November 2014. Patients were identified by infection control practitioners and by screening cerebrospinal fluid samples sent to the central laboratory. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments, and outcomes. Results.  A total of 215 patients were included (166 adults and 49 children). A positive cerebrospinal fluid culture was seen in 106 (49%) patients, with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome was seen in 167 patients (77.7%) and was defined as death in 20 patients (9.3%), persistent vegetative state in 31 patients (14.4%), severe disability in 77 patients (35.8%), or moderate disability in 39 patients (18.1%). On logistic regression analysis, age >45 years (adjusted odds ratio [OR], 6.47; 95% confidence interval [CI], 2.31-18.11; P ≤ .001), abnormal neurological exam (adjusted OR, 3.04; 95% CI, 1.27-7.29; P = .013), and mechanical ventilation (adjusted OR, 5.34; 95% CI, 1.51-18.92; P = .01) were associated with an adverse outcome. Conclusions.  Healthcare-associated meningitis or ventriculitis is associated with significant morbidity and mortality. PMID:27419154

  6. Two pathways through adversity: Predicting well-being and housing outcomes among homeless service users.

    Science.gov (United States)

    Walter, Zoe C; Jetten, Jolanda; Dingle, Genevieve A; Parsell, Cameron; Johnstone, Melissa

    2016-06-01

    People who experience homelessness face many challenges and disadvantages that negatively impact health and well-being and form barriers to achieving stable housing. Further, people who are homeless often have limited social connections and support. Building on previous research that has shown the beneficial effect of group identification on health and well-being, the current study explores the relationship between two social identity processes - multiple group memberships and service identification - and well-being and positive housing outcomes. Measures were collected from 76 participants while they were residing in a homeless accommodation service (T1) and again 2-4 weeks after leaving the service (or 3 months after T1 if participants had not left the service). Mediation analyses revealed that multiple group memberships and service identification at T1 independently predicted well-being at T2 indirectly, via social support. Further, both social identity processes also indirectly predicted housing outcomes via social support. The implications of these findings are twofold. First, while belonging to multiple social groups may provide a pathway to gaining social support and well-being, group belonging may not necessarily be beneficial to achieve stable housing. Second, fostering identification with homeless services may be particularly important as a source of support that contributes to well-being. PMID:26333919

  7. Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Greve, Anders M; Bang, Casper N; Berg, Ronan M G;

    2015-01-01

    ) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se. RESULTS: 1563...... mortality (HR 1.3 per 10min(-1) faster, 95% CI: 1.0-1.7, both p≤0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10min(-1) faster, 95% CI: 1.2-1.7, both p≤0...

  8. A workflow to investigate exposure and pharmacokinetic influences on high-throughput in vitro chemical screening based on adverse outcome pathways, OpenTox USA 2015 Poster

    Science.gov (United States)

    Adverse outcome pathways (AOP) link known population outcomes to a molecular initiating event (MIE) that can be quantified using high-throughput in vitro methods. Practical application of AOPs in chemical-specific risk assessment requires consideration of exposure and absorption,...

  9. Oxygen desaturation in 6-min walk test is a risk factor for adverse outcomes in COPD.

    Science.gov (United States)

    Waatevik, Marie; Johannessen, Ane; Gomez Real, Francisco; Aanerud, Marianne; Hardie, Jon Andrew; Bakke, Per Sigvald; Lind Eagan, Tomas Mikal

    2016-07-01

    The 6-min walk test (6MWT) is an exercise test that measures functional status in chronic obstructive pulmonary disease (COPD) patients and provides information on oxygen desaturation. We investigated oxygen desaturation during 6MWT as a risk factor for important COPD outcomes: mortality, frequency of exacerbations, decline in lung function and decline in lean body mass.433 COPD patients were included in the Bergen COPD Cohort Study 2006-2009, and followed-up for 3 years. Patients were characterised using spirometry, bioelectrical impedance measurements, Charlson comorbidity score, exacerbation history, smoking and arterial blood gases. 370 patients completed the 6MWT at the baseline of the study. Information on all-cause mortality was collected in 2011.Patients who experienced oxygen desaturation during the 6MWT had an approximately twofold increased risk of death (hazard ratio 2.4, 95% CI 1.2-5.1), a 50% increased risk for experiencing later COPD exacerbations (incidence rate ratio 1.6, 95% CI 1.1-2.2), double the yearly rate of decline in both forced vital capacity and forced expiratory volume in 1 s (3.2% and 1.7% versus 1.7% and 0.9%, respectively) and manifold increased yearly rate of loss of lean body mass (0.18 kg·m(-2) versus 0.03 kg·m(-2) among those who did not desaturate).Desaturating COPD patients had a significantly worse prognosis than non-desaturating COPD patients, for multiple important disease outcomes. PMID:27076586

  10. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

    NARCIS (Netherlands)

    Brocklehurst, P.; Kwee, A.; Birthplace in England Collaborative Group

    2011-01-01

    Objective: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design: Prospective cohort study. Setting: England: all NHS trusts providing intrapartum care at home, all freestandi

  11. Maternal caffeine intake from coffee and tea, fetal growth, and the risks of adverse birth outcomes: The Generation R Study

    NARCIS (Netherlands)

    R. Bakker (Rachel); R.P.M. Steegers-Theunissen (Régine); A. Obradov (Aleksandra); H. Raat (Hein); A. Hofman (Albert); V.W.V. Jaddoe (Vincent)

    2010-01-01

    textabstractBackground: Caffeine is a widely used and accepted pharmacologically active substance. The effect of caffeine intake during pregnancy on fetal growth and development is still unclear. Objective: We examined the associations of maternal caffeine intake, on the basis of coffee and tea cons

  12. The Effects of Low Birth Weight on School Performance and Behavioral Outcomes of Elementary School Children in Oman

    Directory of Open Access Journals (Sweden)

    M. Mazharul Islam

    2015-07-01

    Full Text Available Objectives: Our study aimed to examine the effects of low birth weight (LBW on the school performance and behavior of elementary school children in Oman. Methods: Data were gathered through a cross-sectional survey of nine elementary schools from the Muscat and A’Dhahirah regions. The study utilized a unique database created by linking information from the children’s health cards and current academic and behavioral performance records. Information on children’s performance in various areas such as language, mathematics, science, information technology, sports, and behavior were obtained from the school registers. Birth weight (BW and selected sociodemographic data were obtained from the copy of their health cards kept by each school. A total of 542 elementary school children aged 7–11 years, who had completed grades 2–4, were surveyed.  Results: Data from the school register revealed a very high rate (17.7% of LBW and, overall, 12% of the children exhibited below average performance on selected outcome measures. The below average school performance varied from 5–17% across the six selected areas of school performance. The highest rate of below average performance was observed in science (17%, followed by arithmetic and language (16% each. BW showed significant differential effects on school performance and behavioral outcomes, which remained significant after controlling for the effect of potential confounders. It was found that LBW children were 2–6 times more likely to have poorer school performance in all areas than their normal BW peers. Conclusion: Early intervention programs or special care for LBW children in school could be an effective means of improving educational outcomes and the behavior of these children. Attempts should be made to reduce or prevent poor pregnancy outcomes, which, in turn, would reduce the cost of the health, education, and social services systems.

  13. Predictive value of brain-specific proteins in serum for neurodevelopmental outcome after birth asphyxia.

    Science.gov (United States)

    Nagdyman, Nicole; Grimmer, Ingrid; Scholz, Tristess; Muller, Christian; Obladen, Michael

    2003-08-01

    Brain-specific proteins have been used to detect cerebral injury after birth asphyxia. Previous investigations suggest that serum protein S-100beta, brain-specific creatine kinase (CK-BB), and neuron-specific enolase (NSE) are capable of identifying patients with a risk of developing hypoxic-ischemic encephalopathy. Whether detection of elevated serum concentrations of these proteins reflects long-term neurodevelopmental impairment remains to be investigated. We examined serum protein S-100beta, NSE, and CK-BB at 2, 6, 12, and 24 h after birth in 29 asphyxiated infants and 20 control infants. Neurodevelopmental follow-up examinations were performed at 20 mo of age using the German revision of the Griffiths scales for developmental assessment. Elevated concentrations of serum protein S-100beta, NSE, and CK-BB within 24 h after asphyxia did not correlate with long-term neurodevelopmental delay. We conclude that serum protein S-100beta, NSE, and CK-BB, sampled on the first day of life, is of limited value in predicting severe brain damage after birth asphyxia.

  14. The adverse effects of smoking on postoperative outcomes in cancer patients

    Science.gov (United States)

    Gajdos, Csaba; Hawn, Mary T; Campagna, Elizabeth J; Henderson, William G.; Singh, Jasvinder A.; Houston, Thomas

    2014-01-01

    Background The possible negative effects of smoking on postoperative outcomes have not been well-studied in cancer patients. Methods We used the VA Surgical Quality Improvement Program (VASQIP) database for the years 2002–2008, which assesses pre-operative risk factors and post-operative outcomes for patients undergoing major surgery within the VA healthcare system. Results Compared to never smokers, prior smokers and current smokers with GI malignancies were significantly more likely to have surgical site infection (SSI)( Odds ratio, OR:1.25, 95%CI:1.09–1.44)(OR:1.20, 95%CI:1.05–1.38), combined pulmonary complications (CPO: pneumonia, failure to wean from ventilator, reintubation) (OR:1.60, 95%CI:1.38–1.87)(OR:1.96, 95%CI:1.68–2.29) and return to the operating room (OR:1.20, 95%CI:1.03–1.39)(OR:1.31 95%CI:1.13–1.53), respectively. Both prior and current smokers had a significantly higher mortality at 30 days (OR:1.50, 95%CI:1.19–1.89)(OR: 1.41, 95%CI:1.08–1.82) and one year (OR:1.22, 95%CI:1.08–1.38)(OR:1.62, 95%C I:1.43–1.85). Thoracic surgery patients who were current smokers were more likely to develop CPO (OR:1.62, 95%CI:1.25–2.11), and mortality within one year (OR:1.50, 95%CI:1.17–1.92) compared to non-smokers, but SSI rates were not affected by smoking status. Current smokers had a significant increase in postsurgical length of stay (overall 4.3% [p<0.001], GI 4.7% [p=0.003], thoracic 9.0% [p<0.001]) compared to prior smokers. Conclusions Prior and current smoking status is a significant risk factor for major postoperative complications and mortality following GI cancer and thoracic operations in veterans. Smoking cessation should be encouraged prior to all major cancer surgery in the VA population to decrease postoperative complications and length of stay. PMID:22065194

  15. Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living

    Directory of Open Access Journals (Sweden)

    Hogan David B

    2012-09-01

    Full Text Available Abstract Background Few studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items, the Cardiovascular Health Study (CHS frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL residents followed over one year. Methods The three frailty measures and the CHESS scale were derived from assessment items completed among 1,066 AL residents (aged 65+ participating in the Alberta Continuing Care Epidemiological Studies (ACCES. Adjusted risks of one-year mortality, hospitalization and long-term care placement were estimated for those categorized as frail or pre-frail compared with non-frail (or at high/intermediate vs. low risk on CHESS. The area under the ROC curve (AUC was calculated for select models to assess the predictive accuracy of the different frailty measures and CHESS scale in relation to the three outcomes examined. Results Frail subjects defined by the three approaches and those at high risk for decline on CHESS showed a statistically significant increased risk for death and long-term care placement compared with those categorized as either not frail or at low risk for decline. The risk estimates for hospitalization associated with the frailty measures and CHESS were generally weaker with one of the frailty indices (43 items showing no significant association. For death and long-term care placement, the addition of frailty (however derived or CHESS significantly improved on the AUC obtained with a model including only age, sex and co-morbidity, though the magnitude of improvement was sometimes small. The different frailty/risk models did not differ significantly from each other in predicting mortality or hospitalization; however, one of the frailty indices (83 items showed significantly better performance over the other measures in predicting long

  16. Sexual hookups and adverse health outcomes: a longitudinal study of first-year college women.

    Science.gov (United States)

    Fielder, Robyn L; Walsh, Jennifer L; Carey, Kate B; Carey, Michael P

    2014-01-01

    "Hookups" are sexual encounters between partners who are not in a romantic relationship and do not expect commitment. We examined the associations between sexual hookup behavior and depression, sexual victimization (SV), and sexually transmitted infections (STIs) among first-year college women. In this longitudinal study, 483 women completed 13 monthly surveys assessing oral and vaginal sex with hookup and romantic partners, depression, SV, and self-reported STIs. Participants also provided biological specimens that were tested for STIs. During the study, 50% of participants reported hookup sex and 62% reported romantic sex. Covariates included previous levels of the outcome, alcohol use, impulsivity, sensation seeking, and romantic sex. Autoregressive cross-lagged models showed that, controlling for covariates, hookup behavior during college was correlated with depression, Bs = .21, ps sexual hookup behavior among college women was positively correlated with experiencing depression, SV, and STIs, but the nature of these associations remains unclear, and hooking up did not predict future depression. PMID:24350600

  17. Preeclampsia-Eclampsia Adverse Outcomes Reduction: The Preeclampsia-Eclampsia Checklist

    Directory of Open Access Journals (Sweden)

    Oroma B. Nwanodi

    2016-05-01

    Full Text Available Globally, preeclampsia-eclampsia (PE-E is a major cause of puerperal intensive care unit admission, accounting for up to 10% of maternal deaths. PE-E primary prevention is possible. Antepartum low-dose aspirin prophylaxis, costing USD $10–24 can cut the incidence of PE-E in half. Antepartum low molecular weight heparin combined with low-dose aspirin prophylaxis can cut the incidence of early onset PE-E and fetuses that are small for their gestational age in half. Despite predictive antepartum models for PE-E prophylaxis, said prophylaxis is not routinely provided. Therefore, magnesium sulfate secondary prevention of eclampsia remains the globally recommended intervention. Implementation of a PE-E checklist is a continuous quality improvement (CQI tool facilitating appropriate antepartum PE-E prophylaxis and maternal care from the first trimester through the postpartum fourth trimester inter-partum interval. A novel clinical PE-E checklist and implementation strategy are presented below. CQI PE-E checklist implementation and appropriate PE-E prophylaxis provides clinicians and healthcare systems an opportunity to achieve Millennium Development Goals 4 and 5, reducing child mortality and improving maternal health. While CQI checklist implementation may be a tedious ongoing process requiring healthcare team resiliency, improved healthcare outcomes are well worth the effort.

  18. Preeclampsia-Eclampsia Adverse Outcomes Reduction: The Preeclampsia-Eclampsia Checklist.

    Science.gov (United States)

    Nwanodi, Oroma B

    2016-01-01

    Globally, preeclampsia-eclampsia (PE-E) is a major cause of puerperal intensive care unit admission, accounting for up to 10% of maternal deaths. PE-E primary prevention is possible. Antepartum low-dose aspirin prophylaxis, costing USD $10-24 can cut the incidence of PE-E in half. Antepartum low molecular weight heparin combined with low-dose aspirin prophylaxis can cut the incidence of early onset PE-E and fetuses that are small for their gestational age in half. Despite predictive antepartum models for PE-E prophylaxis, said prophylaxis is not routinely provided. Therefore, magnesium sulfate secondary prevention of eclampsia remains the globally recommended intervention. Implementation of a PE-E checklist is a continuous quality improvement (CQI) tool facilitating appropriate antepartum PE-E prophylaxis and maternal care from the first trimester through the postpartum fourth trimester inter-partum interval. A novel clinical PE-E checklist and implementation strategy are presented below. CQI PE-E checklist implementation and appropriate PE-E prophylaxis provides clinicians and healthcare systems an opportunity to achieve Millennium Development Goals 4 and 5, reducing child mortality and improving maternal health. While CQI checklist implementation may be a tedious ongoing process requiring healthcare team resiliency, improved healthcare outcomes are well worth the effort. PMID:27417614

  19. Risk factors for preterm birth, low birth weight, and intrauterine growth retardation in infants born to HIV-infected pregnant women receiving zidovudine

    NARCIS (Netherlands)

    Lambert, JS; Watts, DH; Mofenson, L; Stiehm, ER; Harris, DR; Bethel, J; Whitehouse, J; Jimenez, E; Gandia, J; Scott, G; O'Sullivan, MJ; Kovacs, A; Stek, A; Shearer, WT; Hammill, H; van Dyke, R; Maupin, R; Silio, M; Fowler, MG

    2000-01-01

    Objective: To evaluate independent contributions of maternal factors to adverse pregnancy outcomes (APO) in HIV-infected women receiving antiretroviral therapy (ART). Design: Risk factors for preterm birth (<37 weeks gestation), low birth weight (LBW) (<2500 g), and intrauterine growth retardation (

  20. The effect of obesity on adverse outcomes and metabolism in pediatric burn patients

    Science.gov (United States)

    Kraft, Robert; Herndon, David N.; Williams, Felicia N.; Al-Mousawi, Ahmed M; Finnerty, Celeste C.; Jeschke, Marc G

    2011-01-01

    Hypothesis Obesity influences metabolism and increases the incidence of clinical complications and worsens outcomes in pediatric burn patients. Design Retrospective, single-center study. Subjects Five hundred ninety-two severely burned pediatric patients who had burns covering more than 30% of the total body surface area and who were treated between 2001 and 2008 were enrolled in this study. Patients were divided into ≥ 85th percentile (n = 277) and normal (n = 315) weight groups based on body mass index percentiles. Results Patients stratified below (normal) and ≥ 85th percentile had similar age, gender distribution, and total burn size. No significant differences were detected in the incidence of sepsis (11% for obese vs. 10% for normal), the incidence of multiple organ failure (21% for obese and 16% for normal), or mortality (11% for obese vs. 8% for normal). Compared to the normal group, the ≥ 85th percentile group had low levels of constitutive proteins (α2macroglobulin and Apolipoprotein A-1) (p < 0.05 for both) as well as high levels of triglycerides and the acute-phase protein, C-reactive protein (p < 0.05 for both) up to 60 days after injury. Patients ≥ 85th percentile showed a significant higher loss of bone mineral density and lipolysis compared to normal individuals. Stepwise logistic regression analysis revealed that body mass index had a positive predictive value towards the maximum DENVER2 score, an index of organ failure (p < 0.001). Conclusions BMI ≥ 85th percentile altered the post-burn acute phase and catabolic response but did not increase the incidence of sepsis, multiple organ failure, or mortality in pediatric burn patients. Our results suggest that impaired metabolism and an altered inflammatory response occurs already in patients starting at the 85th percentile BMI. PMID:22143622

  1. Co-morbidity, not age predicts adverse outcome in clostridium difficile colitis

    Institute of Scientific and Technical Information of China (English)

    TS Dharmarajan; M Sipalay; R Shyamsundar; EP Norkus; CS Pitchumoni

    2000-01-01

    AIM To examine whether age alone or comorbidity is a risk factor for death in older adults who developed Clostridium difficile (Cd)colitis during hospitalization.METHODS A retrospective, observational study design was performed in our Lady of Mercy Medical Center, a 650-bed, urban,community-based, university-affiliated teaching hospital. 121 patients with a positive diagnosis of Cd colitis (aged 23- 97 years) were studied, and data pertinent to demographic variables,medical history, co-morbidity, physical examination, and laboratory results were collected. Age was examined as a continuous variable and stratified into Age1 (<80 vs 80 + );Age2 ( < 60, 60 - 69, 70 - 79 and 80 + ); or Age3 (< 60, 60 - 69, 70 - 79, 80 - 89, 90 + ).RESULTS Cd colitis occurs more frequently with advancing age (55% of cases >80 years).However, age, per se, had no effect on mortality. A history of cardiac disease (P= 0.036), recurrent or refractory infection >4 weeks (P--0.007), Iow serum total protein (P=0.034), Iow serum albumin (P=0.001),antibiotic use >4 weeks (P<0.010), use of over 4 antibiotics (P=0.026), and use of certain classes of antibiotics (P = 0.035 - 0.004) were predictive of death. Death was strongly predicted by the use of penicillin-like antibiotics plus clindamycin, in the presence of hypoalbuminemia, refractory sepsis, and cardiac disease ( P = 0.00005). CONCLUSION Cd colitis is common in the very old. However, unlike co-morbidity, age alone does not affect the clinical outcome (survival vs death).

  2. Urine Injury Biomarkers and Risk of Adverse Outcomes in Recipients of Prevalent Kidney Transplants: The Folic Acid for Vascular Outcome Reduction in Transplantation Trial.

    Science.gov (United States)

    Bansal, Nisha; Carpenter, Myra A; Weiner, Daniel E; Levey, Andrew S; Pfeffer, Marc; Kusek, John W; Cai, Jianwen; Hunsicker, Lawrence G; Park, Meyeon; Bennett, Michael; Liu, Kathleen D; Hsu, Chi-Yuan

    2016-07-01

    Recipients of kidney transplants (KTR) are at increased risk for cardiovascular events, graft failure, and death. It is unknown whether urine kidney injury biomarkers are associated with poor outcomes among KTRs. We conducted a post hoc analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial using a case-cohort study design, selecting participants with adjudicated cardiovascular events, graft failure, or death. Urine neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), IL-18, and liver-type fatty acid binding protein (L-FABP) were measured in spot urine samples and standardized to urine creatinine concentration. We adjusted for demographics, cardiovascular risk factors, eGFR, and urine albumin-to-creatinine ratio. Patients had 291 cardiovascular events, 257 graft failure events, and 359 deaths. Each log increase in urine NGAL/creatinine independently associated with a 24% greater risk of cardiovascular events (adjusted hazard ratio [aHR], 1.24; 95% confidence interval [95% CI], 1.06 to 1.45), a 40% greater risk of graft failure (aHR, 1.40; 95% CI, 1.16 to 1.68), and a 44% greater risk of death (aHR, 1.44; 95% CI, 1.26 to 1.65). Urine KIM-1/creatinine and IL-18/creatinine independently associated with greater risk of death (aHR, 1.29; 95% CI, 1.03 to 1.61 and aHR, 1.25; 95% CI, 1.04 to 1.49 per log increase, respectively) but not with risk of cardiovascular events or graft failure. Urine L-FABP did not associate with any study outcomes. In conclusion, among prevalent KTRs, higher urine NGAL, KIM-1, and IL-18 levels independently and differentially associated with greater risk of adverse outcomes. PMID:26538631

  3. The association of maternal vitamin D status with infant birth outcomes, postnatal growth and adiposity in the first 2 years of life in a multi-ethnic Asian population: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort study.

    Science.gov (United States)

    Ong, Yi Lin; Quah, Phaik Ling; Tint, Mya Thway; Aris, Izzuddin M; Chen, Ling Wei; van Dam, Rob M; Heppe, Denise; Saw, Seang-Mei; Godfrey, Keith M; Gluckman, Peter D; Chong, Yap Seng; Yap, Fabian; Lee, Yung Seng; Foong-Fong Chong, Mary

    2016-08-01

    Maternal vitamin D status during pregnancy has been associated with infant birth and postnatal growth outcomes, but reported findings have been inconsistent, especially in relation to postnatal growth and adiposity outcomes. In a mother-offspring cohort in Singapore, maternal plasma vitamin D was measured between 26 and 28 weeks of gestation, and anthropometric measurements were obtained from singleton offspring during the first 2 years of life with 3-month follow-up intervals to examine birth, growth and adiposity outcomes. Associations were analysed using multivariable linear regression. Of a total of 910 mothers, 13·2 % were vitamin D deficient (<50 nmol/l) and 26·5 % were insufficient (50-75 nmol/l). After adjustment for potential confounders and multiple testing, no statistically significant associations were observed between maternal vitamin D status and any of the birth outcomes - small for gestational age (OR 1·00; 95 % CI 0·56, 1·79) and pre-term birth (OR 1·16; 95 % CI 0·64, 2·11) - growth outcomes - weight-for-age z-scores, length-for-age z-scores, circumferences of the head, abdomen and mid-arm at birth or postnatally - and adiposity outcomes - BMI, and skinfold thickness (triceps, biceps and subscapular) at birth or postnatally. Maternal vitamin D status in pregnancy did not influence infant birth outcomes, postnatal growth and adiposity outcomes in this cohort, perhaps due to the low prevalence (1·6 % of the cohort) of severe maternal vitamin D deficiency (defined as of <30·0 nmol/l) in our population. PMID:27339329

  4. Clinical Presentation and Birth Outcomes Associated with Respiratory Syncytial Virus Infection in Pregnancy.

    Directory of Open Access Journals (Sweden)

    Helen Y Chu

    Full Text Available Respiratory syncytial virus (RSV is the most important cause of viral pneumonia in children worldwide. A maternal vaccine may protect both the mother and infant from RSV illness. The epidemiology and clinical presentation of RSV in pregnant and postpartum women is not well-described.Data were collected from a prospective, randomized trial of influenza immunization in pregnant women in rural southern Nepal. Women were enrolled in their second trimester of pregnancy and followed until six months postpartum. Active weekly home-based surveillance for febrile respiratory illness was performed. Mid-nasal swabs collected with episodes of respiratory illness were tested for RSV by real-time polymerase chain reaction.RSV was detected in 14 (0.4% illness episodes in 3693 women over 3554 person-years of surveillance from 2011-2014. RSV incidence was 3.9/1000 person-years overall, and 11.8/1000 person-years between September and December. Seven (50% women sought care for RSV illness; none died. Of the 7 (50% illness episodes during pregnancy, all had live births with 2 (29% preterm births and a median birthweight of 3060 grams. This compares to 469 (13% preterm births and a median birthweight of 2790 grams in women without RSV during pregnancy. Of the 7 mothers with postpartum RSV infection, RSV was detected in 4 (57% of their infants.RSV was an uncommon cause of febrile respiratory illness in mothers during pregnancy in Nepal. These data will inform prevention and therapeutic strategies against RSV in resource-limited settings.

  5. 不良妊娠结局现状及其影响因素分析%Current status of adverse pregnancy outcomes and their influencing factors

    Institute of Scientific and Technical Information of China (English)

    李媛媛; 张海鲲; 李忠良; 张成元

    2014-01-01

    Objective To investigate the current status of adverse pregnancy outcomes and their major influencing factors .Methods Totally 698 pregnant women visiting hospital were randomly selected from 2 hospitals in Shandong Weifang from May 2012 to May 2013.The general situation of newborns ’ mother and father , pregnancy and delivery data were obtained through maternal clinical records , birth records, on-the-spot inquiry and follow-up.Multiple logistic regression analysis was conducted to screen the major influencing factors of pregnancy outcomes .Results The incidence of adverse pregnancy outcomes was 15.09%.Good maternal nutritional status was protective factor of pregnancy outcomes (OR=2.28, 95%CI:1.47-3.54, P<0.05).Risk factors included advanced maternal age , long-term medication history , maternal history of abnormal pregnancy , pregnancy complications , bacterial or viral infection , history of exposure to harmful factors, abnormal amniotic fluid and placenta (all P<0.05).Conclusion Childbearing women are advocated to deliver at best childbearing age .Maternal nutrition should be balanced , and exposure to harmful factors such as pesticide should be reduced .Health care during pregnancy and childbirth needs to be emphasized , and special attention should be paid to the prevention of infection , pregnancy complications , abnormal placenta and amniotic fluid abnormality .%目的:了解不良妊娠结局的现状并探讨其主要影响因素。方法随机抽取山东省潍坊市2家医院2012年5月至2013年5月期间就诊的孕产妇共计698人,通过查阅产妇病例、新生儿出生记录、现场询问和随访获得产妇和新生儿父亲的一般情况、孕期及分娩情况等资料,应用多因素Logistic回归分析筛选妊娠结局的主要影响因素。结果不良妊娠结局的发生率为15.09%;产妇营养状况好为妊娠结局的保护性因素(OR=2.28,95%CI:1.47~3.54,P<0.05);而高龄产妇、

  6. Endocrine-Disrupting Activity of Hydraulic Fracturing Chemicals and Adverse Health Outcomes After Prenatal Exposure in Male Mice.

    Science.gov (United States)

    Kassotis, Christopher D; Klemp, Kara C; Vu, Danh C; Lin, Chung-Ho; Meng, Chun-Xia; Besch-Williford, Cynthia L; Pinatti, Lisa; Zoeller, R Thomas; Drobnis, Erma Z; Balise, Victoria D; Isiguzo, Chiamaka J; Williams, Michelle A; Tillitt, Donald E; Nagel, Susan C

    2015-12-01

    Oil and natural gas operations have been shown to contaminate surface and ground water with endocrine-disrupting chemicals. In the current study, we fill several gaps in our understanding of the potential environmental impacts related to this process. We measured the endocrine-disrupting activities of 24 chemicals used and/or produced by oil and gas operations for five nuclear receptors using a reporter gene assay in human endometrial cancer cells. We also quantified the concentration of 16 of these chemicals in oil and gas wastewater samples. Finally, we assessed reproductive and developmental outcomes in male C57BL/6J mice after the prenatal exposure to a mixture of these chemicals. We found that 23 commonly used oil and natural gas operation chemicals can activate or inhibit the estrogen, androgen, glucocorticoid, progesterone, and/or thyroid receptors, and mixtures of these chemicals can behave synergistically, additively, or antagonistically in vitro. Prenatal exposure to a mixture of 23 oil and gas operation chemicals at 3, 30, and 300 μg/kg · d caused decreased sperm counts and increased testes, body, heart, and thymus weights and increased serum testosterone in male mice, suggesting multiple organ system impacts. Our results suggest possible adverse developmental and reproductive health outcomes in humans and animals exposed to potential environmentally relevant levels of oil and gas operation chemicals. PMID:26465197

  7. Endocrine-Disrupting Activity of Hydraulic Fracturing Chemicals and Adverse Health Outcomes After Prenatal Exposure in Male Mice.

    Science.gov (United States)

    Kassotis, Christopher D; Klemp, Kara C; Vu, Danh C; Lin, Chung-Ho; Meng, Chun-Xia; Besch-Williford, Cynthia L; Pinatti, Lisa; Zoeller, R Thomas; Drobnis, Erma Z; Balise, Victoria D; Isiguzo, Chiamaka J; Williams, Michelle A; Tillitt, Donald E; Nagel, Susan C

    2015-12-01

    Oil and natural gas operations have been shown to contaminate surface and ground water with endocrine-disrupting chemicals. In the current study, we fill several gaps in our understanding of the potential environmental impacts related to this process. We measured the endocrine-disrupting activities of 24 chemicals used and/or produced by oil and gas operations for five nuclear receptors using a reporter gene assay in human endometrial cancer cells. We also quantified the concentration of 16 of these chemicals in oil and gas wastewater samples. Finally, we assessed reproductive and developmental outcomes in male C57BL/6J mice after the prenatal exposure to a mixture of these chemicals. We found that 23 commonly used oil and natural gas operation chemicals can activate or inhibit the estrogen, androgen, glucocorticoid, progesterone, and/or thyroid receptors, and mixtures of these chemicals can behave synergistically, additively, or antagonistically in vitro. Prenatal exposure to a mixture of 23 oil and gas operation chemicals at 3, 30, and 300 μg/kg · d caused decreased sperm counts and increased testes, body, heart, and thymus weights and increased serum testosterone in male mice, suggesting multiple organ system impacts. Our results suggest possible adverse developmental and reproductive health outcomes in humans and animals exposed to potential environmentally relevant levels of oil and gas operation chemicals.

  8. Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies

    Directory of Open Access Journals (Sweden)

    Luciano Potena

    2013-01-01

    Full Text Available HLA antibodies (HLA ab in transplant candidates have been associated with poor outcome. However, clinical relevance of noncytotoxic antibodies after heart transplant (HT is controversial. By using a Luminex-based HLA screening, we retested pretransplant sera from HT recipients testing negative for cytotoxic HLA ab and for prospective crossmatch. Out of the 173 consecutive patients assayed (52±13y; 16% females; 47% ischemic etiology, 32 (18% showed pretransplant HLA ab, and 12 (7% tested positive against both class I and class II HLA. Recipients with any HLA ab had poorer survival than those without (65±9 versus 82±3%; P=0.02, accounting for a doubled independent mortality risk (P=0.04. In addition, HLA-ab detection was associated with increased prevalence of early graft failure (35 versus 15%; P=0.05 and late cellular rejection (29 versus 11%; P=0.03. Of the subgroup of 37 patients suspected for antibody mediated rejection (AMR, the 9 with pretransplant HLA ab were more likely to display pathological AMR grade 2 (P=0.04. By an inexpensive, luminex-based, HLA-screening assay, we were able to detect non-cytotoxic HLA ab predicting fatal and nonfatal adverse outcomes after heart transplant. Allocation strategies and desensitization protocols need to be developed and prospectively tested in these patients.

  9. Planned home birth: benefits, risks, and opportunities

    Directory of Open Access Journals (Sweden)

    Zielinski R

    2015-04-01

    Full Text Available Ruth Zielinski,1 Kelly Ackerson,2 Lisa Kane Low1,3,4 1School of Nursing, University of Michigan, Ann Arbor, MI, USA; 2Bronson School of Nursing, Western Michigan University, Kalamazoo, MI, USA; 3Department of Obstetrics and Gynecology, Medical School, University of Michigan, Ann Arbor, MI, USA; 4Women’s Studies Department, University of Michigan, Ann Arbor, MI, USA Abstract: While the number of women in developed countries who plan a home birth is low, the number has increased over the past decade in the US, and there is evidence that more women would choose this option if it were readily available. Rates of planned home birth range from 0.1% in Sweden to 20% in the Netherlands, where home birth has always been an integrated part of the maternity system. Benefits of planned home birth include lower rates of maternal morbidity, such as postpartum hemorrhage, and perineal lacerations, and lower rates of interventions such as episiotomy, instrumental vaginal birth, and cesarean birth. Women who have a planned home birth have high rates of satisfaction related to home being a more comfortable environment and feeling more in control of the experience. While maternal outcomes related to planned birth at home have been consistently positive within the literature, reported neonatal outcomes during planned home birth are more variable. While the majority of investigations of planned home birth compared with hospital birth have found no difference in intrapartum fetal deaths, neonatal deaths, low Apgar scores, or admission to the neonatal intensive care unit, there have been reports in the US, as well as a meta-analysis, that indicated more adverse neonatal outcomes associated with home birth. There are multiple challenges associated with research designs focused on planned home birth, in part because conducting randomized controlled trials is not feasible. This report will review current research studies published between 2004 and 2014 related to

  10. Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low- and middle-income countries: a WHO secondary analysis.

    Directory of Open Access Journals (Sweden)

    Ver Luanni Bilano

    Full Text Available BACKGROUND: Pre-eclampsia has an immense adverse impact on maternal and perinatal health especially in low- and middle-income settings. We aimed to estimate the associations between pre-eclampsia/eclampsia and its risk factors, and adverse maternal and perinatal outcomes. METHODS: We performed a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health. The survey was a multi-country, facility-based cross-sectional study. A global sample consisting of 24 countries from three regions and 373 health facilities was obtained via a stratified multi-stage cluster sampling design. Maternal and offspring data were extracted from records using standardized questionnaires. Multi-level logistic regression modelling was conducted with random effects at the individual, facility and country levels. RESULTS: Data for 276,388 mothers and their infants was analysed. The prevalence of pre-eclampsia/eclampsia in the study population was 10,754 (4%. At the individual level, sociodemographic characteristics of maternal age ≥30 years and low educational attainment were significantly associated with higher risk of pre-eclampsia/eclampsia. As for clinical and obstetric variables, high body mass index (BMI, nulliparity (AOR: 2.04; 95%CI 1.92-2.16, absence of antenatal care (AOR: 1.41; 95%CI 1.26-1.57, chronic hypertension (AOR: 7.75; 95%CI 6.77-8.87, gestational diabetes (AOR: 2.00; 95%CI 1.63-2.45, cardiac or renal disease (AOR: 2.38; 95%CI 1.86-3.05, pyelonephritis or urinary tract infection (AOR: 1.13; 95%CI 1.03-1.24 and severe anemia (AOR: 2.98; 95%CI 2.47-3.61 were found to be significant risk factors, while having >8 visits of antenatal care was protective (AOR: 0.90; 95%CI 0.83-0.98. Pre-eclampsia/eclampsia was found to be a significant risk factor for maternal death, perinatal death, preterm birth and low birthweight. CONCLUSION: Chronic hypertension, obesity and severe anemia were the highest risk factors of preeclampsia

  11. Outcomes and milestone achievement differences for very low-birth-weight multiples compared with singleton infants.

    Science.gov (United States)

    Kirkby, Sharon; Genen, Linda; Turenne, Wendy; Dysart, Kevin

    2010-06-01

    We examined if very low-birth-weight (VLBW) infants of multiple gestation pregnancies experience more complications and take longer to achieve clinical milestones compared with similar singletons. We performed a retrospective analysis of all infants less than 1500 g at birth in a large neonatal database. Singletons were compared with twins and higher-order multiples for demographic, morbidities, and process milestones including feeding, respiratory, thermoregulation, and length of stay. Multivariable regression analyses were performed to control for potential confounding variables. A total of 5507 infants were included: 3792 singletons, 1391 twins, and 324 higher-order multiples. There were no differences in Apgar scores, small for gestational age status, and incidence of necrotizing enterocolitis, severe retinopathy of prematurity, severe intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, or the need for surgery. Multiples had higher rates of apnea and patent ductus arteriosus than singletons. VLBW multiples achieved milestones at similar rates in most areas compared with singletons except for the achievement of full oral feedings. Length of stay, after controlling for confounding variables, did not differ between the groups. Compared with singletons, VLBW multiples had similar morbidity and achieved most feeding and thermoregulation milestones at similar rates.

  12. An approach to 'dynamic--DDD (defined daily dose) monitoring' to reduce adverse clinical outcomes and increase patient safety: information repositories and event triggers in clinical practice.

    Science.gov (United States)

    Eryilmaz, Esat N

    2011-01-01

    The goal of every effort and actions/interventions in almost all healthcare settings throughout the world's health systems -primary care, inpatient, outpatient encounters, diagnostic and therapeutic interventions, peri-operative settings- is and has been to achieve a well defined outcome (a kind of improvement in health status of the patient under consideration, an observable and significant change(s) in selected set(s) of clinical parameters confirmed by laboratory results and pathology findings, improvements in clinical outcomes). Clinical inefficiencies, in this context, should be addressed very systematically and scientifically. This is achieved through a continuously monitoring approach to adverse drug events based on information repositories and evidence-based rule sets. For monitoring drug-related outcomes and clinical outcomes in general, the concept of DDD (Defined Daily Dose) compliance is explained in this article to eliminate and avoid adverse clinical outcomes.

  13. Alcohol Involvement in Sexual Behaviour and Adverse Sexual Health Outcomes from 26 to 38 Years of Age.

    Directory of Open Access Journals (Sweden)

    Jennie L Connor

    Full Text Available Research on alcohol and sexual behaviour has focused on young adults or high-risk groups, showing alcohol use contributing to riskier sexual choices. Adults now in their late thirties have been exposed to heavier drinking norms than previously, raising questions about effects on sexual wellbeing. We examined self-reported use and consequences of alcohol in sexual contexts, and its association with usual drinking pattern at age 38, and also associations of heavy drinking occasion (HDO frequency with number of sexual partners, sexually transmitted infections (STIs, and terminations of pregnancy (TOPs, from 26-32 and 32-38 years of age.Members of the Dunedin Study birth cohort answered computer-presented questions about sexual behaviour and outcomes, and interviewer-administered alcohol consumption questions, at age 26, 32 and 38 years.Response level was >90% at each assessment. At 38, drinking before or during sex in the previous year was common (8.2% of men; 14.6% of women reported "usually/always", and unwanted consequences were reported by 13.5% of men and 11.9% of women, including regretted sex or failure to use contraception or condoms. Frequent heavy drinkers were more likely to "use alcohol to make it easier to have sex" and regret partner choice, particularly women. Heavy drinking frequency was strongly associated with partner numbers for men and women at 32, but only for women at 38. Significantly higher odds of STIs amongst the heaviest drinking men, and TOPs amongst the heaviest drinking women were seen at 32-38.Alcohol involvement in sex continues beyond young adulthood where it has been well documented, and is common at 38. Women appear to be more affected than men, and heavy drinking is associated with poorer outcomes for both. Improving sexual health and wellbeing throughout the life course needs to take account of the role of alcohol in sexual behaviour.

  14. Increased expression of EphA7 correlates with adverse outcome in primary and recurrent glioblastoma multiforme patients

    Directory of Open Access Journals (Sweden)

    Rose Frank

    2008-03-01

    Full Text Available Abstract Background Malignant gliomas are lethal cancers, highly dependent on angiogenesis and treatment options and prognosis still remain poor for patients with recurrent glioblastoma multiforme (GBM. Ephs and ephrins have many well-defined functions during embryonic development of central nervous system such as axon mapping, neural crest cell migration, hindbrain segmentation and synapse formation as well as physiological and abnormal angiogenesis. Accumulating evidence indicates that Eph and ephrins are frequently overexpressed in different tumor types including GBM. However, their role in tumorigenesis remains controversial, as both tumor growth promoter and suppressor potential have been ascribed to Eph and ephrins while the function of EphA7 in GBM pathogenesis remains largely unknown. Methods In this study, we investigated the immunohistochemical expression of EphA7 in a series of 32 primary and recurrent GBM and correlated it with clinical pathological parameters and patient outcome. In addition, intratumor microvascular density (MVD was quantified by immunostaining for endothelial cell marker von Willebrand factor (vWF. Results Overexpression of EphA7 protein was predictive of the adverse outcome in GBM patients, independent of MVD expression (p = 0.02. Moreover, high density of MVD as well as higher EphA7 expression predicted the disease outcome more accurately than EphA7 variable alone (p = 0.01. There was no correlation between MVD and overall survival or recurrence-free survival (p > 0.05. However, a statistically significant correlation between lower MVD and tumor recurrence was observed (p = 0.003. Conclusion The immunohistochemical assessment of tissue EphA7 provides important prognostic information in GBM and would justify its use as surrogate marker to screen patients for tyrosine kinase inhibitor therapy.

  15. Mental Health in Low Birth Weight Individuals Approaching Adulthood

    OpenAIRE

    Lund, Line Knutsen

    2012-01-01

    In developed countries, an increasing number of children have survived after preterm birth during the latest decades. These children are surviving at the borders of viability and are at increased risk for a number of adverse outcomes. Few studies have followed low birth weight populations into adulthood. In this study, three groups of children born in the Trøndelag counties of Norway in 1986-88 have been followed up from birth to twenty years of age. Two groups born with low birth weight were...

  16. Life course path analysis of birth weight, childhood growth, and adult systolic blood pressure

    DEFF Research Database (Denmark)

    Gamborg, Michael; Andersen, Per Kragh; Baker, Jennifer L;

    2009-01-01

    The inverse associations between birth weight and later adverse health outcomes and the positive associations between adult body size and poor health imply that increases in relative body size between birth and adulthood may be undesirable. In this paper, the authors describe life course path ana...

  17. Temporal changes in key maternal and fetal factors affecting birth outcomes: A 32-year population-based study in an industrial city

    Directory of Open Access Journals (Sweden)

    Pearce Mark S

    2008-08-01

    Full Text Available Abstract Background The link between maternal factors and birth outcomes is well established. Substantial changes in society and medical care over time have influenced women's reproductive choices and health, subsequently affecting birth outcomes. The objective of this study was to describe temporal changes in key maternal and fetal factors affecting birth outcomes in Newcastle upon Tyne over three decades, 1961–1992. Methods For these descriptive analyses we used data from a population-based birth record database constructed for the historical cohort Particulate Matter and Perinatal Events Research (PAMPER study. The PAMPER database was created using details from paper-based hospital delivery and neonatal records for all births during 1961–1992 to mothers resident in Newcastle (out of a total of 109,086 singleton births, 97,809 hospital births with relevant information. In addition to hospital records, we used other sources for data collection on births not included in the delivery and neonatal records, for death and stillbirth registrations and for validation. Results The average family size decreased mainly due to a decline in the proportion of families with 3 or more children. The distribution of mean maternal ages in all and in primiparous women was lowest in the mid 1970s, corresponding to a peak in the proportion of teenage mothers. The proportion of older mothers declined until the late 1970s (from 16.5% to 3.4% followed by a steady increase. Mean birthweight in all and term babies gradually increased from the mid 1970s. The increase in the percentage of preterm birth paralleled a two-fold increase in the percentage of caesarean section among preterm births during the last two decades. The gap between the most affluent and the most deprived groups of the population widened over the three decades. Conclusion Key maternal and fetal factors affecting birth outcomes, such as maternal age, parity, socioeconomic status, birthweight and

  18. Intestinal Microbiota-Dependent Phosphatidylcholine Metabolites, Diastolic Dysfunction and Adverse Clinical Outcomes in Chronic Systolic Heart Failure

    Science.gov (United States)

    Wilson Tang, W. H.; Wang, Zeneng; Shrestha, Kevin; Borowski, Allen G; Wu, Yuping; Troughton, Richard W; Klein, Allan L; Hazen, Stanley L

    2014-01-01

    Background Trimethylamine-N-oxide (TMAO) has been linked to increased cardiovascular risk. We aim to determine the prognostic value of TMAO and its dietary precursors, choline and betaine, in heart failure (HF). Methods and Results In 112 patients with chronic systolic HF with comprehensive echocardiographic evaluation, we measured plasma TMAO, choline, and betaine by mass spectrometry. Median TMAO levels, choline, and betaine levels were 5.8 [3.6, 12.1] μM, 10.9 [8.4, 14.0] μM, 43.8 [37.1, 53.0] μM, respectively, and were correlated with each other (all p<0.0001 for both). TMAO levels were significantly higher in patients with diabetes mellitus (9.4 [4.9, 13.2] vs 4.8 [3.4, 9.8] μM, p=0.005) and in subjects with New York Heart Association (NYHA) class III or greater (7.0 [4.7, 14.8] vs 4.7 [3.4, 11.3] μM, p=0.02). Elevated TMAO, choline, and betaine levels were each associated with higher plasma NT-proBNP levels and more advanced left ventricular diastolic dysfunction, but not systolic dysfunction or inflammatory and endothelial biomarkers. Higher choline (Hazard ratio (HR) 1.64 [95% CI: 1.22 2.20], p=0.001), betaine (HR 1.51 [1.10–2.08], p=0.01), and TMAO (HR 1.48 [1.10–1.96], p=0.01) predicted increased risk for 5-year adverse clinical events (death/transplant). Only higher TMAO levels predicted incident adverse clinical events independent of age, eGFR, mitral E/septal Ea, and NT-proBNP levels (HR 1.46 [1.03 2.14], p=0.03). Conclusion Elevated plasma TMAO, choline and betaine levels are each associated with more advanced left ventricular diastolic dysfunction and portend poorer long-term adverse clinical outcomes in chronic systolic HF. However, only higher plasma TMAO levels was associated with poor prognosis after adjustment for cardio-renal indices. PMID:25459686

  19. The association of daily physical activity and birth outcome: A population-based cohort study

    NARCIS (Netherlands)

    M.I. Both (Marieke); M.A. Overvest (Mathilde); M.F. Wildhagen (Mark); J. Golding (Jean); H.I.J. Wildschut (Hajo)

    2010-01-01

    textabstractThe potential relationship between daily physical activity and pregnancy outcome remains unclear because of the wide variation in study designs and physical activity assessment measures. We sought to prospectively quantify the potential effects of the various domains of physical activity

  20. Residential traffic exposure and pregnancy-related outcomes: A prospective birth cohort study

    NARCIS (Netherlands)

    Hooven, E.H. van den; Jaddoe, V.W.; Kluizenaar, Y. de; Hofman, A.; MacKenbach, J.P.; Steegers, E.A.; Miedema, H.M.; Pierik, F.H.

    2009-01-01

    Background. The effects of ambient air pollution on pregnancy outcomes are under debate. Previous studies have used different air pollution exposure assessment methods. The considerable traffic-related intra-urban spatial variation needs to be considered in exposure assessment. Residential proximity

  1. Residential traffic exposure and pregnancy-related outcomes: A prospective birth cohort study

    NARCIS (Netherlands)

    E.H. van den Hooven (Edith); V.W.V. Jaddoe (Vincent); Y. de Kluizenaar (Yvonne); A. Hofman (Albert); J.P. Mackenbach (Johan); R.P.M. Steegers-Theunissen (Régine); H.M. Miedema (Henk); F.H. Pierik (Frank)

    2009-01-01

    textabstractBackground. The effects of ambient air pollution on pregnancy outcomes are under debate. Previous studies have used different air pollution exposure assessment methods. The considerable traffic-related intra-urban spatial variation needs to be considered in exposure assessment. Residenti

  2. An exploratory investigation of various modes of action and potential adverse outcomes of fluoxetine in marine mussels

    Energy Technology Data Exchange (ETDEWEB)

    Franzellitti, Silvia, E-mail: silvia.franzellitti@unibo.it [University of Bologna, Interdepartment Centre for Environmental Science Research, via S. Alberto 163, 48123 Ravenna (Italy); University of Bologna, Department of Biological, Geological, and Environmental Sciences, via Selmi 3, 40100 Bologna (Italy); Buratti, Sara; Capolupo, Marco [University of Bologna, Interdepartment Centre for Environmental Science Research, via S. Alberto 163, 48123 Ravenna (Italy); Du, Bowen; Haddad, Samuel P. [Department of Environmental Science, Baylor University, Waco, TX 76798 (United States); Chambliss, C. Kevin [Department of Chemistry and Biochemistry, Baylor University, Waco, TX 76798 (United States); Brooks, Bryan W. [Department of Environmental Science, Baylor University, Waco, TX 76798 (United States); Fabbri, Elena [University of Bologna, Interdepartment Centre for Environmental Science Research, via S. Alberto 163, 48123 Ravenna (Italy); University of Bologna, Department of Biological, Geological, and Environmental Sciences, via Selmi 3, 40100 Bologna (Italy)

    2014-06-01

    Highlights: • Mode of action (MOA) related endpoints and biomarkers of toxicity were assessed in mussels exposed to fluoxetine (FX). • Significant FX bioaccumulation was observed in tissues of mussels exposed to 30 and 300 ng/L FX. • Alterations of cAMP-related cell signaling were observed in exposed mussels as part of the MOA of FX. • FX reduced the health status of mussels inducing lysosomal effects in digestive gland and antioxidant responses in gills. • The importance of considering additional MOAs and adverse outcome pathways for FX impacts on mussels is highlighted. - Abstract: The present study investigated possible adverse outcome pathways (AOPs) of the antidepressant fluoxetine (FX) in the marine mussel Mytilus galloprovincialis. An evaluation of molecular endpoints involved in modes of action (MOAs) of FX and biomarkers for sub-lethal toxicity were explored in mussels after a 7-day administration of nominal FX concentrations encompassing a range of environmentally relevant values (0.03–300 ng/L). FX bioaccumulated in mussel tissues after treatment with 30 and 300 ng/L FX, resulting in bioconcentration factor (BCF) values ranging from 200 to 800, which were higher than expected based solely on hydrophobic partitioning models. Because FX acts as a selective serotonin (5-HT) re-uptake inhibitor increasing serotonergic neurotransmission at mammalian synapses, cell signaling alterations triggered by 5-HT receptor occupations were assessed. cAMP levels and PKA activities were decreased in digestive gland and mantle/gonads of FX-treated mussels, consistent with an increased occupation of 5-HT1 receptors negatively coupled to the cAMP/PKA pathway. mRNA levels of a ABCB gene encoding the P-glycoprotein were also significantly down-regulated. This membrane transporter acts in detoxification towards xenobiotics and in altering pharmacokinetics of antidepressants; moreover, it is under a cAMP/PKA transcriptional regulation in mussels. Potential stress

  3. Intraventricular hemorrhage in very low birth weight infants: associated risk factors and outcome in the neonatal period

    Directory of Open Access Journals (Sweden)

    Mancini Monique Catache

    1999-01-01

    Full Text Available Intraventricular hemorrhage (IVH is a severe complication in very low birth weight (VLBW newborns (NB. With the purpose of studying the incidence of IVH, the associated risk factors, and the outcomes for these neonates, we studied all the VLBW infants born in our neonatal unit. Birth weight, gestational age, presence of perinatal asphyxia, mechanical ventilation, length of hospitalization, apnea crisis, hydrocephalus, and periventricular leukomalacia were analyzed. The diagnosis of IVH was based on ultrasound scan studies (Papile's classification performed until the tenth day of life and repeated weekly in the presence of abnormalities. Sixty-seven/101 neonates were studied. The mortality rate was 30.6% (31/101 and the incidence of IVH was 29.8% (20/67 : 70% grade I, 20% grade III and 10% grade IV. The incidence of IVH in NB <1,000 g was 53.8% (p = 0.035 and for gestational age <30 weeks was 47.3% (p = 0.04, both considered risk factors for IVH. The length of hospitalization (p = 0.00015 and mechanical ventilation (p = 0.038 were longer in IHV NB. The IVH NB had a relative risk of 2.3 of developing apnea (p = 0.02, 3.7 of hydrocephalus (p = 0.0007, and 7.7 of periventricular leukomalacia (p < 0.00001. The authors emphasize the importance of knowing the risk factors related to IVH so as to introduce prevention schemes to reduce IVH and to improve outcomes of affected newborns.

  4. Early Caffeine Use in Very Low Birth Weight Infants and Neonatal Outcomes: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Park, Hye Won; Lim, Gina; Chung, Sung-Hoon; Chung, Sochung; Kim, Kyo Sun; Kim, Soo-Nyung

    2015-12-01

    The use of caffeine citrate for treatment of apnea in very low birth weight infants showed short-term and long-term benefits. A systematic review and meta-analysis of the literature was undertaken to document the effect providing caffeine early (0-2 days of life) compared to providing caffeine late (≥3 days of life) in very low birth weight infants on several neonatal outcomes, including bronchopulmonary dysplasia (BPD). We searched MEDLINE, the EMBASE database, the Cochrane Library, and KoreaMed for this meta-analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale and Jadad's scale. Studies were included if they examined the effect of the early use of caffeine compared with the late use of caffeine. Two reviewers screened the candidate articles and extracted the data from the full-text of all of the included studies. We included a total of 59,136 participants (range 58,997-59,136; variable in one study) from a total of 5 studies. The risk of death (odds ratio [OR], 0.902; 95% confidence interval [CI], 0.828 to 0.983; P=0.019), bronchopulmonary dysplasia (BPD) (OR, 0.507; 95% CI, 0.396 to 0.648; Pcaffeine group. Early caffeine use was not associated with a risk of necrotizing enterocolitis (NEC) and NEC requiring surgery. This meta-analysis suggests that early caffeine use has beneficial effects on neonatal outcomes, including mortality and BPD, without increasing the risk of NEC.

  5. Residential traffic exposure and pregnancy-related outcomes: a prospective birth cohort study

    OpenAIRE

    Hofman Albert; De Kluizenaar Yvonne; Jaddoe Vincent WV; van den Hooven Edith H; Mackenbach Johan P; Steegers Eric AP; Miedema Henk ME; Pierik Frank H

    2009-01-01

    Abstract Background The effects of ambient air pollution on pregnancy outcomes are under debate. Previous studies have used different air pollution exposure assessment methods. The considerable traffic-related intra-urban spatial variation needs to be considered in exposure assessment. Residential proximity to traffic is a proxy for traffic-related exposures that takes into account within-city contrasts. Methods We investigated the association between residential proximity to traffic and vari...

  6. Preterm birth by vacuum extraction and neonatal outcome: a population-based cohort study

    OpenAIRE

    Åberg, Katarina; Norman, Mikael; Ekéus, Cecilia

    2014-01-01

    Background Very few studies have investigated the neonatal outcomes after vacuum extraction delivery (VE) in the preterm period and the results of these studies are inconclusive. The objective of this study was to describe the use of VE for preterm delivery in Sweden and to compare rates of neonatal complications after preterm delivery by VE to those found after cesarean section during labor (CS) or unassisted vaginal delivery (VD). Methods Data was obtained from Swedish national registers. I...

  7. Evidence of a Gene × Environment Interaction Between Birth Weight and Genetic Risk in the Prediction of Criminogenic Outcomes Among Adolescent Males.

    Science.gov (United States)

    Jackson, Dylan B; Beaver, Kevin M

    2016-01-01

    A number of studies have revealed that low birth weight children have a heightened risk of various maladaptive outcomes, including academic challenges and delinquent involvement. However, very little research to date has examined whether the relationship between low birth weight, poor academic performance, and delinquent peer affiliation is moderated by genetic risk. Using data from the National Longitudinal study of Adolescent Health, the present study examines whether male adolescents born at very low birth weights are significantly predisposed to poor academic performance and delinquent peer affiliation. Moreover, we test whether the effect of birth weight on these outcomes is conditioned by level of genetic risk. We find no evidence that very low birth weight males are more likely to affiliate with delinquent peers or perform poorly in school during adolescence. However, upon examining gene-environment interactions, we find that being born at a very low birth weight does significantly increase the odds of poor academic performance and delinquent peer affiliation among males who possess a higher level of genetic risk. Limitations are noted and the implications of the findings are discussed. PMID:25145687

  8. An individualized approach to sustained inflation duration at birth improves outcomes in newborn preterm lambs.

    Science.gov (United States)

    Tingay, David G; Lavizzari, Anna; Zonneveld, Cornelis E E; Rajapaksa, Anushi; Zannin, Emanuela; Perkins, Elizabeth; Black, Don; Sourial, Magdy; Dellacà, Raffaele L; Mosca, Fabio; Adler, Andy; Grychtol, Bartłomiej; Frerichs, Inéz; Davis, Peter G

    2015-11-15

    A sustained first inflation (SI) at birth may aid lung liquid clearance and aeration, but the impact of SI duration relative to the volume-response of the lung is poorly understood. We compared three SI strategies: 1) variable duration defined by attaining volume equilibrium using real-time electrical impedance tomography (EIT; SIplat); 2) 30 s beyond equilibrium (SIlong); 3) short 30-s SI (SI30); and 4) positive pressure ventilation without SI (no-SI) on spatiotemporal aeration and ventilation (EIT), gas exchange, lung mechanics, and regional early markers of injury in preterm lambs. Fifty-nine fetal-instrumented lambs were ventilated for 60 min after applying the allocated first inflation strategy. At study completion molecular and histological markers of lung injury were analyzed. The time to SI volume equilibrium, and resultant volume, were highly variable; mean (SD) 55 (34) s, coefficient of variability 59%. SIplat and SIlong resulted in better lung mechanics, gas exchange and lower ventilator settings than both no-SI and SI30. At 60 min, alveolar-arterial difference in oxygen was a mean (95% confidence interval) 130 (13, 249) higher in SI30 vs. SIlong group (two-way ANOVA). These differences were due to better spatiotemporal aeration and tidal ventilation, although all groups showed redistribution of aeration towards the nondependent lung by 60 min. Histological lung injury scores mirrored spatiotemporal change in aeration and were greatest in SI30 group (P benefit over positive pressure ventilation alone. PMID:26408555

  9. ATLANTIC-DIP: raised maternal body mass index (BMI) adversely affects maternal and foetal outcomes in glucose tolerant women classified using International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria

    LENUS (Irish Health Repository)

    Dennedy, MC

    2011-09-15

    Background and aims: Raised maternal body mass index (BMI), in association with hyperglycaemia is associated with adverse pregnancy outcome. Whether BMI has an independent effect on adverse pregnancy outcome is not clear. We aimed to investigate the effects of raised maternal BMI on pregnancy outcome in glucose tolerant women, classified using the IADPSG criteria.\\r\

  10. H-Y Antigen Incompatibility Not Associated with Adverse Immunologic Graft Outcomes: Deceased Donor Pair Analysis of the OPTN Database

    Directory of Open Access Journals (Sweden)

    Douglas Scott Keith

    2011-01-01

    Full Text Available Background. H-Y antigen incompatibility adversely impacts bone marrow transplants however, the relevance of these antigens in kidney transplantation is uncertain. Three previous retrospective studies of kidney transplant databases have produced conflicting results. Methods. This study analyzed the Organ Procurement and Transplantation Network database between 1997 and 2009 using male deceased donor kidney transplant pairs in which the recipient genders were discordant. Death censored graft survival at six months, five, and ten years, treated acute rejection at six months and one year, and rates of graft failure by cause were the primary endpoints analyzed. Results. Death censored graft survival at six months was significantly worse for female recipients. Analysis of the causes of graft failure at six months revealed that the difference in death censored graft survival was due primarily to nonimmunologic graft failures. The adjusted and unadjusted death censored graft survivals at five and ten years were similar between the two genders as were the rates of immunologic graft failure. No difference in the rates of treated acute rejection at six months and one year was seen between the two genders. Conclusions. Male donor to female recipient discordance had no discernable effect on immunologically mediated kidney graft outcomes in the era of modern immunosuppression.

  11. A three-tiered approach for linking pharmacokinetic considerations to the adverse outcome pathway framework for chemical-specific risk assessment

    Science.gov (United States)

    The power of the adverse outcome pathway (AOP) framework arises from its utilization of pathway-based data to describe the initial interaction of a chemical with a molecular target (molecular initiating event; (MIE), followed by a progression through a series of key events that l...

  12. The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction: results of the multicenter PORTO Study.

    LENUS (Irish Health Repository)

    Flood, Karen

    2014-05-06

    The aim of the Prospective Observational Trial to Optimize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with estimated fetal weight (EFW) <10(th) centile. The objective of this secondary analysis was to describe the role of the cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome.

  13. Contribution of overweight and obesity to the occurrence of adverse pregnancy outcomes in a multi-ethnic cohort : population attributive fractions for Amsterdam

    NARCIS (Netherlands)

    Djelantik, A. A. A. M. J.; Kunst, A. E.; van der Wal, M. F.; Smit, H. A.; Vrijkotte, T. G. M.

    2012-01-01

    Objective To estimate the contribution of pre-pregnancy excessive weight to the occurrence of adverse pregnancy outcomes and to detect the differences in these contributions between different ethnic groups. Design Prospective multi-ethnic community-based cohort study. Setting The prevalence of exces

  14. Adapting biomarker technologies to adverse outcome pathways (AOPs) research: current thoughts on using in vivo discovery for developing in vitro target methods

    Science.gov (United States)

    Adverse outcome pathways (AOP) research is a relatively new concept in human systems biology for assessing the molecular level linkage from an initiating (chemical) event that could lead to a disease state. Although most implementations of AOPs are based on liquids analyses, the...

  15. Role of the Varroa mite in honeybee (Apis mellifera) colony loss: A case study for adverse outcome pathway development with a nonchemical stressor

    Science.gov (United States)

    Significant honeybee colony losses have been reported across North America and Europe in recent years. A number of factors, both chemical and nonchemical, have been associated with such losses. Adverse outcome pathways (AOPs) provide a conceptual framework to describe and evalu...

  16. Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC).

    LENUS (Irish Health Repository)

    O Caoimh, Rónán

    2014-09-19

    Functional decline and frailty are common in community dwelling older adults, increasing the risk of adverse outcomes. Given this, we investigated the prevalence of frailty-associated risk factors and their distribution according to the severity of perceived risk in a cohort of community dwelling older adults, using the Risk Instrument for Screening in the Community (RISC).

  17. Traffic-Related Air Toxics and Term Low Birth Weight in Los Angeles County, California

    OpenAIRE

    Wilhelm, Michelle; Ghosh, Jo Kay; Su, Jason; Cockburn, Myles; Jerrett, Michael; Ritz, Beate

    2011-01-01

    Background: Numerous studies have linked criteria air pollutants with adverse birth outcomes, but there is less information on the importance of specific emission sources, such as traffic, and air toxics. Objectives: We used three exposure data sources to examine odds of term low birth weight (LBW) in Los Angeles, California, women when exposed to high levels of traffic-related air pollutants during pregnancy. Methods: We identified term births during 1 June 2004 to 30 March 2006 to women res...

  18. Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes

    OpenAIRE

    Watson-Jones, D.; Gumodoka, B; H. Weiss; Changalucha, J; Todd, J.; Mugeye, K; Buvé, A; Kanga, Z; Ndeki, L; Rusizoka, M.; Ross, D.; Marealle, J.; Balira, R; Mabey, D; Hayes, R

    2002-01-01

    Treatment for maternal syphilis with single-dose benzathine penicillin (2.4 million units intramuscularly) is being implemented in many parts of sub-Saharan Africa. To examine the effectiveness of this regimen, a prospective cohort of 1688 pregnant women was recruited in Tanzania. Birth outcomes were compared among women treated for high-titer (n=133; rapid plasma reagin [RPR] titer > or = 1:8 and Treponema pallidum hemagglutination assay [TPHA]/fluorescent treponemal antibody [FTA] positive)...

  19. Maternal diet, prenatal exposure to dioxin-like compounds and birth outcomes in a European prospective mother–child study (NewGeneris)

    DEFF Research Database (Denmark)

    Papadopoulou, Eleni; Kogevinas, Manolis; Botsivali, Maria;

    2014-01-01

    Maternal diet can result in exposure to environmental contaminants including dioxins which may influence foetal growth. We investigated the association between maternal diet and birth outcomes by defining a dioxin-rich diet. We used validated food frequency questionnaires to assess the diet of pr...

  20. Effects of paternal and maternal lifestyle factors on pregnancy complications and perinatal outcome. A population-based birth-cohort study : the GECKO Drenthe cohort

    NARCIS (Netherlands)

    Mutsaerts, M. A. Q.; Groen, H.; Buiter-Van der Meer, A.; Sijtsma, A.; Sauer, P. J. J.; Land, J. A.; Mol, B. W.; Corpeleijn, E.; Hoek, A.

    2014-01-01

    Do paternal and maternal lifestyle factors influence the risk of hypertensive pregnancy complications, gestational diabetes mellitus (GDM), spontaneous preterm birth and small-for-gestational-age (SGA)? Paternal lifestyle factors do not exert an independent effect on the investigated outcomes while

  1. Hospital work and pregnancy outcomes: a study in the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Suárez-Varela, María M Morales; Kaerlev, Linda; Zhu, Jin Liang;

    2009-01-01

    the risk of reproductive failures. Our aim was to study pregnancy outcomes in female hospital workers in Denmark. We performed a cohort study of 5976 female hospital workers and used as a reference group 60,890 women employed outside of hospitals. The reproductive health of hospital workers working......In hospitals, women of reproductive age do a range of work tasks, some of which are known to carry potential risks. Tasks such as working with radiation, chemicals, and infectious agents, as well as performing heavy lifting or tasks requiring erratic sleep patterns have been reported to increase...... during pregnancy is comparable to those of non-hospital workers for the majority of reproductive failures studied. However, an increased prevalence of congenital abnormalities was noted in some subgroups of hospital workers, which may indicate that some hospital work still entails fetotoxic hazards....

  2. Parental investments in child health - maternal health behaviours and birth outcomes

    DEFF Research Database (Denmark)

    Wüst, Miriam

    A growing economic literature has begun to focus on the effect of parental investments in child health in developed countries. However, this literature is not conclusive. Empirical work has concentrated on estimating the effect of a wide set of parental inputs comprising maternal health behaviours...... like smoking, alcohol consumption or diet. As most of these inputs are parental choices and we commonly do not observe all inputs relevant for the child production function, estimates on the effect of health inputs suffer from endogeneity bias. This paper explores the effect of smoking, alcohol...... compares different estimation strategies based on diverging identifying assumptions on the nature of the heterogeneity between families and parental response to child health outcomes. It acknowledges that prenatal resource allocation is a dynamic process, i.e. that parental preferences, perceptions about...

  3. Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context.

    Science.gov (United States)

    Binder, Pauline; Johnsdotter, Sara; Essén, Birgitta

    2012-12-01

    Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a 'maternal migration effect' as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the 'three delays' framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005-2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of 'broken trust, which can be mutually held between women and providers. An additional factor is women's 'negative responses to future care', which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 'language discordance' can lead to a 'reliance on interpreter service', which can cause delays in Phase 3, when 'reciprocal incongruent language ability' is worsened by suboptimal interpreter systems

  4. An adverse outcome pathway framework for neural tube and axial defects mediated by modulation of retinoic acid homeostasis.

    Science.gov (United States)

    Tonk, Elisa C M; Pennings, Jeroen L A; Piersma, Aldert H

    2015-08-01

    Developmental toxicity can be caused through a multitude of mechanisms and can therefore not be captured through a single simple mechanistic paradigm. However, it may be possible to define a selected group of overarching mechanisms that might allow detection of the vast majority of developmental toxicants. Against this background, we have explored the usefulness of retinoic acid mediated regulation of neural tube and axial patterning as a general mechanism that, when perturbed, may result in manifestations of developmental toxicity that may cover a large part of malformations known to occur in experimental animals and in man. Through a literature survey, we have identified key genes in the regulation of retinoic acid homeostasis, as well as marker genes of neural tube and axial patterning, that may be used to detect developmental toxicants in in vitro systems. A retinoic acid-neural tube/axial patterning adverse outcome pathway (RA-NTA AOP) framework was designed. The framework was tested against existing data of flusilazole exposure in the rat whole embryo culture, the zebrafish embryotoxicity test, and the embryonic stem cell test. Flusilazole is known to interact with retinoic acid homeostasis, and induced common and unique NTA marker gene changes in the three test systems. Flusilazole-induced changes were similar in directionality to gene expression responses after retinoic acid exposure. It is suggested that the RA-NTA framework may provide a general tool to define mechanistic pathways and biomarkers of developmental toxicity that may be used in alternative in vitro assays for the detection of embryotoxic compounds.

  5. A systematic review of patient-reported outcome instruments of dermatologic adverse events associated with targeted cancer therapies

    Science.gov (United States)

    Chan, Alexandre; Cameron, Michael C.; Garden, Benjamin; Boers-Doets, Christine B.; Schindler, Katja; Epstein, Joel B.; Choi, Jennifer; Beamer, Laura; Roeland, Eric; Russi, Elvio G.; Bensadoun, René-Jean; Teo, Yi Ling; Chan, Raymond J.; Shih, Vivianne; Bryce, Jane; Raber-Durlacher, Judith; Gerber, Peter Arne; Freytes, César O.; Rapoport, Bernardo; LeBoeuf, Nicole; Sibaud, Vincent; Lacouture, Mario E.

    2016-01-01

    Purpose Dermatologic adverse events (dAE) in cancer treatment are frequent with use of targeted therapies. These dAEs have been shown to have significant impact on health-related quality of life (HRQoL). While standardized assessment tools have been developed for physicians to assess severity of dAEs, there is a discord between objective and subjective measures. The identification of patient-reported outcome (PRO) instruments useful in the context of targeted cancer therapies is therefore important in both the clinical and research settings for the overall evaluation of dAEs and their impact on HRQoL. Methods A comprehensive, systematic literature search of published articles was conducted by two independent reviewers in order to identify PRO instruments previously utilized in patient populations with dAEs from targeted cancer therapies. The identified PRO instruments were studied to determine which HRQoL issues relevant to dAEs were addressed, as well as the process of development and validation of these instruments. Results Thirteen articles identifying six PRO instruments met the inclusion criteria. Four instruments were general dermatology (Skindex-16©, Skindex-29©, Dermatology Life Quality Index [DLQI], and DIELH-24), and two were symptom-specific (Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitors-18 [FACT-EGFRI-18] and Hand-Foot Syndrome 14 [HFS-14]). Conclusions While there are several PRO instruments that have been tested in the context of targeted cancer therapy, additional work is needed to develop new instruments and to further validate the instruments identified in this study in patients receiving targeted therapies. PMID:25564221

  6. Defining catastrophic costs and comparing their importance for adverse tuberculosis outcome with multi-drug resistance: a prospective cohort study, Peru.

    Directory of Open Access Journals (Sweden)

    Tom Wingfield

    2014-07-01

    Full Text Available Even when tuberculosis (TB treatment is free, hidden costs incurred by patients and their households (TB-affected households may worsen poverty and health. Extreme TB-associated costs have been termed "catastrophic" but are poorly defined. We studied TB-affected households' hidden costs and their association with adverse TB outcome to create a clinically relevant definition of catastrophic costs.From 26 October 2002 to 30 November 2009, TB patients (n = 876, 11% with multi-drug-resistant [MDR] TB and healthy controls (n = 487 were recruited to a prospective cohort study in shantytowns in Lima, Peru. Patients were interviewed prior to and every 2-4 wk throughout treatment, recording direct (household expenses and indirect (lost income TB-related costs. Costs were expressed as a proportion of the household's annual income. In poorer households, costs were lower but constituted a higher proportion of the household's annual income: 27% (95% CI = 20%-43% in the least-poor houses versus 48% (95% CI = 36%-50% in the poorest. Adverse TB outcome was defined as death, treatment abandonment or treatment failure during therapy, or recurrence within 2 y. 23% (166/725 of patients with a defined treatment outcome had an adverse outcome. Total costs ≥20% of household annual income was defined as catastrophic because this threshold was most strongly associated with adverse TB outcome. Catastrophic costs were incurred by 345 households (39%. Having MDR TB was associated with a higher likelihood of incurring catastrophic costs (54% [95% CI = 43%-61%] versus 38% [95% CI = 34%-41%], p<0.003. Adverse outcome was independently associated with MDR TB (odds ratio [OR] = 8.4 [95% CI = 4.7-15], p<0.001, previous TB (OR = 2.1 [95% CI = 1.3-3.5], p = 0.005, days too unwell to work pre-treatment (OR = 1.01 [95% CI = 1.00-1.01], p = 0.02, and catastrophic costs (OR = 1.7 [95% CI = 1.1-2.6], p = 0.01. The

  7. Stromal Cell-Derived Factor 1 Gene Polymorphism Is Associated with Susceptibility to Adverse Long-Term Allograft Outcomes in Non-Diabetic Kidney Transplant Recipients

    Directory of Open Access Journals (Sweden)

    Chung-Jieh Wang

    2014-07-01

    Full Text Available Although the genetic polymorphism of Stromal Cell-Derived Factor 1 (SDF-1 is associated with higher mortality of liver allograft recipients, the role of SDF-1 in the modulation of renal allograft outcomes is unclear. Between March 2000 and January 2008, we recruited 252 non-diabetic renal transplant recipients (RTRs. Baseline characteristics and blood chemistry were recorded. Genomic DNA extraction with polymerase chain reaction-restriction fragment length polymorphism was utilized to analyze the genetic polymorphisms of SDF-1 (rs1801157. The influence of SDF-1 on an adverse renal allograft outcome, defined as either a doubling of serum creatinine, graft failure, or patient death was evaluated. Sixteen patients with the SDF-1 AA/AG genotype and nine with the SDF-1 GG genotype reached an adverse outcome. According to Kaplan-Meier analysis, patients carrying the SDF-1 AA/AG genotype or A allele showed a significantly higher risk of reaching an adverse outcome than those carrying the SDF-1 GG genotype or G allele (p = 0.041; p = 0.0051, respectively; log rank test. Stepwise multivariate Cox proportional regression analysis revealed that patients carrying the SDF-1 AA/AG genotype and A allele had a 2.742-fold (95% CI. 1.106–6.799, p = 0.03 and 2.306-fold (95% CI. 1.254–4.24, p = 0.008 risk of experiencing an adverse outcome. The SDF-1 AA/AG genotype and A allele have a detrimental impact on the long-term outcome of RTRs.

  8. A Summary of Pathways or Mechanisms Linking Preconception Maternal Nutrition with Birth Outcomes.

    Science.gov (United States)

    King, Janet C

    2016-07-01

    Population, human, animal, tissue, and molecular studies show collectively and consistently that maternal nutrition in the pre- or periconception period influences fetal growth and development, which subsequently affects the individual's long-term health. It is known that nutrition during pregnancy is an important determinant of the offspring's growth and health. However, now there is evidence that the mother's nutritional status at conception also influences pregnancy outcome and long-term health. For example, the mother's nutritional status at conception influences the way energy is partitioned between maternal and fetal needs. Furthermore, placental development during the first weeks of gestation reflects maternal nutrition and establishes mechanisms for balancing maternal and fetal nutritional needs. Also, maternal nutritional signals at fertilization influence epigenetic remodeling of fetal genes. These findings all indicate that maternal parenting begins before conception. The following papers from a symposium on preconception nutrition presented at the 2015 Scientific Sessions and Annual Meeting of the ASN emphasize the importance of maternal nutrition at conception on the growth and long-term health of the child. PMID:27281808

  9. Outcome of Very Lov Birth Weight Infants in Neonatal Care Unit of Dicle University Faculty of Medicine

    Directory of Open Access Journals (Sweden)

    Selahattin Katar

    2006-01-01

    Full Text Available Our purpose was to determine mortality and morbidity rates and selected outcome variables for infants weighing less than 1500 g, who were admitted to the neonatal care unit of our hospital from April 2005 to February 2006.The number of VLBW admissions to the our neonatal care unit was 91, fourty one percent female and %49 were male. The mean birth weight was 1191±261 g and gestational age was 29±2.4 weeks. The mortality rate was 37.3 %. Antenatal steroids had been given to only 8% of mothers. The most important maternal risk factors were preeclampsia/eclampsia 30%, premature rupture of membranes 13%, hemorhage 8%. Respiratory distress syndrome was diagnosed 47%, surfactant was given to 40% of these infants. The major causes of death were sepsis, respiratuar distres syndrome, and extreme prematurity.Compared with reports from other developed NICU, VLBW infants at our center had higher mortality rates. We conclude that, the major cause of high mortality rate depends on low-social –cultural –education conditions associated with insufficient prenatal care, neonatal care and inaccurate neonatal transport in our region.

  10. Evaluating legacy contaminants and emerging chemicals in marine environments using adverse outcome pathways and biological effects-directed analysis.

    Science.gov (United States)

    Hutchinson, Thomas H; Lyons, Brett P; Thain, John E; Law, Robin J

    2013-09-30

    important scientific, economic and health challenges. In order to meet these challenges and pursue cost-effective scientific approaches that can provide evidence necessary to support policy needs (e.g. the European Marine Strategy Framework Directive), it is widely recognised that there is a need to (i) provide marine exposure assessments for priority contaminants using a range of validated models, passive samplers and biomarkers; (ii) integrate chemical monitoring data with biological effects data across spatial and temporal scales (including quality controls); and (iii) strengthen the evidence base to understand the relationship between exposure to complex chemical mixtures, biological and ecological impacts through integrated approaches and molecular data (e.g. genomics, proteomics and metabolomics). Additionally, we support the widely held view that (iv) that rather than increasing the analytical chemistry monitoring of large number of emerging contaminants, it will be important to target analytical chemistry towards key groups of chemicals of concern using effects-directed analysis. It is also important to evaluate to what extent existing biomarkers and bioassays can address various classes of emerging chemicals using the adverse outcome pathway (AOP) approach now being developed by the Organization for Economic Cooperation and Development (OECD) with respect to human toxicology and ecotoxicology.

  11. Evaluating legacy contaminants and emerging chemicals in marine environments using adverse outcome pathways and biological effects-directed analysis

    International Nuclear Information System (INIS)

    important scientific, economic and health challenges. In order to meet these challenges and pursue cost-effective scientific approaches that can provide evidence necessary to support policy needs (e.g. the European Marine Strategy Framework Directive), it is widely recognised that there is a need to (i) provide marine exposure assessments for priority contaminants using a range of validated models, passive samplers and biomarkers; (ii) integrate chemical monitoring data with biological effects data across spatial and temporal scales (including quality controls); and (iii) strengthen the evidence base to understand the relationship between exposure to complex chemical mixtures, biological and ecological impacts through integrated approaches and molecular data (e.g. genomics, proteomics and metabolomics). Additionally, we support the widely held view that (iv) that rather than increasing the analytical chemistry monitoring of large number of emerging contaminants, it will be important to target analytical chemistry towards key groups of chemicals of concern using effects-directed analysis. It is also important to evaluate to what extent existing biomarkers and bioassays can address various classes of emerging chemicals using the adverse outcome pathway (AOP) approach now being developed by the Organization for Economic Cooperation and Development (OECD) with respect to human toxicology and ecotoxicology

  12. Maternal serum disintegrin and metalloprotease protein-12 in early pregnancy as a potential marker of adverse pregnancy outcomes.

    Directory of Open Access Journals (Sweden)

    Jiexia Yang

    Full Text Available OBJECTIVES: The aim of this study was to determine whether the concentration of disintegrin and metalloprotease protein12 (ADAM12 in first trimester maternal serum can be used as a marker for first-trimester complete spontaneous abortions, missed abortions, ectopic pregnancies and hydatidiform moles. METHODS: The maternal serum concentrations of ADAM12 were measured in the range of 5-9+6 weeks of gestation using an automated AutoDelfia immunoassay platform in 9 cases of complete spontaneous abortion, 27 cases of missed abortions, 56 cases of ectopic pregnancies, 12 cases of hydatidiform moles, and 100 controls. Logistic regression analysis was used to determine significant factors for predicting adverse pregnancy outcomes in early pregnancy. Screening performance was assessed using receiver operating characteristic curves. RESULTS: Two hundred and four women were enrolled in the study. In the control group, the level of ADAM12 increased with gestational age. The median ADAM12 levels in the spontaneous abortion (0.430 MoM, ectopic pregnancy (0.460 MoM and hydatidiform mole (0.037 MoM groups were lower than that in the control group, while the median ADAM12 level in the missed abortion group (1.062 MoM was not significant from the controls (1.002 MoM. Logistic regression analysis demonstrated that the level of ADAM12 in maternal serum facilitated the detection of ectopic pregnancies (OR = 0.909; 95% CI = 0.841 ∼ 0.982 and complete spontaneous abortion (OR = 0.863; 95% CI = 0.787 ∼ 0.946. CONCLUSIONS: In complete spontaneous abortion and ectopic pregnancy, ADAM12 maintained at low levels in early pregnancies, and there were significant differences compared to normal pregnancies. ADAM12 is a promising marker for the diagnosis of complete spontaneous abortion and ectopic pregnancy in symptomatic women, and under certain conditions, ADAM12 can diagnose ectopic pregnancy and spontaneous abortion before an ultrasonographic detection of the

  13. Child Maltreatment and Adolescent Mental Health Problems in a Large Birth Cohort

    Science.gov (United States)

    Mills, Ryan; Scott, James; Alati, Rosa; O'Callaghan, Michael; Najman, Jake M.; Strathearn, Lane

    2013-01-01

    Objective: To examine whether notified child maltreatment is associated with adverse psychological outcomes in adolescence, and whether differing patterns of psychological outcome are seen depending on the type of maltreatment. Methods: The participants were 7,223 mother and child pairs enrolled in a population-based birth cohort study in…

  14. Who are the Women Who Work in Their Last Month of Pregnancy? Social and Occupational Characteristics and Birth Outcomes of Women Working Until the Last Month of Pregnancy in France.

    Science.gov (United States)

    Vigoureux, Solène; Blondel, Béatrice; Ringa, Virginie; Saurel-Cubizolles, Marie-Josèphe

    2016-09-01

    Introduction The prenatal leave law in France protects women during pregnancy and their employment. We aimed to estimate the proportion of women who worked late in their pregnancy, to analyze the occupational, social and medical factors associated with late prenatal leave and to compare the pregnancy outcome of these women and those who left earlier in the pregnancy. Methods The sample was extracted from the 2010 French National Perinatal Survey. All women who delivered within a 1-week period were interviewed before discharge from the maternity unit. Women with a singleton live birth at or after 37 weeks' gestation and who were working during pregnancy (n = 8463) were included. Data were collected on employment, date of leave, and sociodemographic and medical characteristics. Results Overall, 328 women (3.9 %) took a late prenatal leave (at or after 37 weeks' gestation). Women who left late were older than 30 years old, with a high educational level and were living in an urban area. Being self-employed and having a managerial or upper-intellectual occupation was highly associated with late leave, before and after controlling for relevant variables. Perinatal and delivery outcomes were similar for women who took a late leave and those who left before 37 weeks' gestation. Discussion Occupational characteristics are the main determinants of late prenatal leave. Women working in the last month of pregnancy had a favorable social and occupational situation and did not did not experience an adverse pregnancy or birth outcome. Other studies are needed to understand the reasons for late leave and evaluate the post-partum fatigue and health of these women. PMID:27106839

  15. 高血糖对不良妊娠结局的影响%The impact of hyperglycemia on adverse pregnancy outcomes

    Institute of Scientific and Technical Information of China (English)

    潘燕飞; 沈洁

    2012-01-01

    糖尿病合并妊娠、妊娠期糖尿病以及轻微妊娠高血糖均可引起不良妊娠结局的风险增加.并且,不良妊娠结局的发生及转归受血糖代谢异常的类型、严重程度、持续时间以及血糖水平等因素的影响.高血糖增加不良妊娠结局风险的机制仍不明确,有效的并发症预测因素仍需证实.此外,母婴并发症的血糖阈值存在很大争议.基于既往多为回顾性研究,因此需要大规模前瞻性研究去进一步探讨高血糖与不良妊娠结局的关系.%Diabetes mellitus with pregnancy,gestational diabetes mellims,as well as mild pregnant hyperglycemia could increase the risk of adverse pregnancy outcomes.And the incidence and prognosis of adverse pregnancy outcomes relate to the type,severity,duration of abnormal glucose metabolism,and the level of blood glucose,etc.The mechanism of hyperglycemia on the higher risk of adverse pregnancy outcomes remains unclear.Reliable predictors of complications need to be investigated.In addition,it is rather controversial to determine the blood glucose threshold for maternal and fetal complications.Due to the known results mostly deriving from retrospective studies,large-scale prospective studies are required to further explore the relationship of hyperglycemia and adverse pregnancy outcomes.

  16. 孕中期异常甲胎蛋白与不良妊娠结局的相关性%The association between second - trimester maternal serum abnormal alpha - fetoprotein and adverse pregnancy outcome

    Institute of Scientific and Technical Information of China (English)

    吴满武; 俞信忠; 杨志浩; 张涛; 罗婷婷

    2012-01-01

    目的 探讨孕中期甲胎蛋白(AFP)与不良妊娠结局的相关性,为妊娠管理提供建议.方法 对孕中期14 008例孕妇进行唐氏筛查.研究组:①AFP MoM>2.0孕妇338例.②AFP MoM<0.5孕妇224例.依据AFP MoM值不同分组.对照组:AFP MoM值都在正常范围内的孕妇318例.回顾分析妊娠结局资料.结果 ①AFP MoM>2.0的孕妇发生出生缺陷(ρ<0.01)的机会明显比正常孕妇高.②AFP MoM> 3.5的孕妇发生出生缺陷(P<0.001)和早产(P<0.05)的机会明显比正常孕妇高.③AFP MoM> 5.0的孕妇发生出生缺陷(P<0.001)、早产(P<0.01)和胎儿窘迫(P<0.05)的机会明显比正常孕妇高.④AFP MoM<0.5和<0.25的孕妇均未发现与不良妊娠结局相关.结论 异常水平的标志物除了能够提供开放性神经管缺损风险外,还能提供不良妊娠结局的风险信息,而这些信息对产前遗传咨询和妊娠管理是非常重要.%Objective; Aim of this study is to determine the association between risk of adverse pregnancy outcome and abnormal maternal serum alpha - fetoprotein in second trimester screening. Abnormal levels of maternal serum markers provide information which is important for counseling and pregnancy management. Methods: A total of 14 008 pregnant women underwent maternal serum Down' s syndrome screening. Study groups include:①338 cases were found to have a serum AFP of > 2.0 multiples of the median ( MoM). ②cases serum were found to have a serum AFP 2.0 MoM have higher occurrence of birth defects (P 3. 5 MoM have higher occurrence of birth defects ( P 5.0 MoM have higher occurrence of birth defects (P < 0. 001) and preterm labor ( P < 0. 01) and fetal stress ( P < 0. 05). ④Pregnant women with a serum AFP of < 0. 5 M < 0. 25 MoM were found to have no association with adverse outcomes. Conclusion: Abnormal levels of maternal serum markers can provide risk information of adverse outcomes in addition to the risks for open neural tube defects

  17. Eating for Two in Pregnancy: Health outcomes in pregnant women and their children

    OpenAIRE

    Tielemans, Myrte

    2016-01-01

    textabstractAdverse pregnancy and birth outcomes such as pre-eclampsia and preterm birth are prevalent worldwide and are important causes of maternal and perinatal mortality and morbidity. To reduce the occurrence of these adverse outcomes, risk factors should be identified that could be modified in pregnancy. Such modifiable risk factors may be maternal nutrition and gestational weight gain. However, not all aspects of maternal diet during pregnancy have been studied in relation with pregnan...

  18. Teenage childbearing : pregnancy outcomes and long-term consequences for the mothers

    OpenAIRE

    Otterblad Olausson, Petra

    2000-01-01

    The purposes of the thesis were to study effects of low maternal age on adverse pregnancy outcomes, predictors of teenage childbearing, and long-term effects of teenage motherhood on the women's social situation later in life and risk of premature death. The effects of low maternal age at first birth on risks of adverse pregnancy outcomes, primarily preterm birth and infant mortality, were studied in three population-based cohort studies. We used the Swedish Medical Birt...

  19. Planned place of birth

    DEFF Research Database (Denmark)

    Overgaard, Charlotte; Coxon, Kirstie; Stewart, Mary

    Title Planned place of birth: issues of choice, access and equity. Outline In Northern European countries, giving birth is generally safe for healthy women with uncomplicated pregnancies, and their babies. However, place of birth can affect women’s outcomes and experiences of birth. Whilst tertiary...... in Denmark Coxon K et al: Planned place of birth in England: perceptions of accessing obstetric units, midwife led units and home birth amongst women and their partners. How these papers interrelate These papers draw upon recent research in maternity care, undertaken in Denmark and in England. In both...

  20. Birthing positions during second stage of labor and long-term psychological outcomes in low-risk women

    NARCIS (Netherlands)

    Jonge, A. de; Rijnders, M.E.B.; Diem, M.T. van; Scheepers, P.L.H.; Lagro-Janssen, A.L.M.

    2011-01-01

    PURPOSE: To examine the long-term influence of birthing positions during the second stage of labor, as well as other factors, on birth satisfaction, self-esteem (based on the Rosenberg Self-esteem Scale [RSE]) and emotional well-being (based on the Edinburgh Postnatal Depression Scale [EPDS]). STUDY

  1. Risk factors and adverse perinatal outcomes among term and preterm infants born small-for-gestational-age: secondary analyses of the WHO Multi-Country Survey on Maternal and Newborn Health.

    Directory of Open Access Journals (Sweden)

    Erika Ota

    Full Text Available Small for gestational age (SGA is not only a major indicator of perinatal mortality and morbidity, but also the morbidity risks in later in life. We aim to estimate the association between the birth of SGA infants and the risk factors and adverse perinatal outcomes among twenty-nine countries in Africa, Latin America, the Middle East and Asia in 359 health facilities in 2010-11.We analysed facility-based, cross-sectional data from the WHO Multi-country Survey on Maternal and Newborn Health. We constructed multilevel logistic regression models with random effects for facilities and countries to estimate the risk factors for SGA infants using country-specific birthweight reference standards in preterm and term delivery, and SGA's association with adverse perinatal outcomes. We compared the risks and adverse perinatal outcomes with appropriate for gestational age (AGA infants categorized by preterm and term delivery.A total of 295,829 singleton infants delivered were analysed. The overall prevalence of SGA was highest in Cambodia (18.8%, Nepal (17.9%, the Occupied Palestinian Territory (16.1%, and Japan (16.0%, while the lowest was observed in Afghanistan (4.8%, Uganda (6.6% and Thailand (9.7%. The risk of preterm SGA infants was significantly higher among nulliparous mothers and mothers with chronic hypertension and preeclampsia/eclampsia (aOR: 2.89; 95% CI: 2.55-3.28 compared with AGA infants. Higher risks of term SGA were observed among sociodemographic factors and women with preeclampsia/eclampsia, anaemia and other medical conditions. Multiparity (> = 3 (AOR: 0.88; 95% CI: 0.83-0.92 was a protective factor for term SGA. The risk of perinatal mortality was significantly higher in preterm SGA deliveries in low to high HDI countries.Preterm SGA is associated with medical conditions related to preeclampsia, but not with sociodemographic status. Term SGA is associated with sociodemographic status and various medical conditions.

  2. Association of variants in NEDD4L with blood pressure response and adverse cardiovascular outcomes in hypertensive patients treated with thiazide diuretics

    Science.gov (United States)

    McDonough, Caitrin W.; Burbage, Sarah E.; Duarte, Julio D.; Gong, Yan; Langaee, Taimour Y.; Turner, Stephen T.; Gums, John G.; Chapman, Arlene B.; Bailey, Kent R.; Beitelshees, Amber L.; Boerwinkle, Eric; Pepine, Carl J.; Cooper-DeHoff, Rhonda M.; Johnson, Julie A.

    2013-01-01

    Objective Single-nucleotide polymorphisms (SNPs) in NEDD4L may influence the ability of the NEDD4L protein to reduce epithelial sodium channel expression. A variant in NEDD4L, rs4149601, was associated with antihypertensive response and cardiovascular outcomes during treatment with thiazide diuretics and β-blockers in a Swedish population. We sought to further evaluate associations between NEDD4L polymorphisms, blood pressure response and cardiovascular outcomes with thiazide diuretics and β-blockers. Methods Four SNPs, rs4149601, rs292449, rs1008899 and rs75982813, were genotyped in 767 patients from the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) clinical trial and association was assessed with blood pressure response to hydrochlorothiazide and atenolol. One SNP, rs4149601, was also genotyped in 1345 patients from the International Verapmil SR Trandolapril Study (INVEST), and association was examined with adverse cardiovascular outcomes relative to hydrochlorothiazide treatment. Results Significant associations or trends were found between rs4149601, rs292449, rs75982813 and rs1008899 and decreases in blood pressure in whites on hydrochlorothiazide, and a significant association was observed with increasing copies of the GC rs4149601-rs292449 haplotype and greater blood pressure response to hydrochlorothiazide in whites (P = 0.0006 and 0.006, SBP and DBP, respectively). Significant associations were also seen with rs4149601 and an increased risk for adverse cardiovascular outcomes in whites not treated with hydrochlorothiazide [P = 0.022, odds ratio (95% confidence interval) = 10.65 (1.18–96.25)]. Conclusion NEDD4L rs4149601, rs292449 and rs75982813 may be predictors for blood pressure response to hydrochlorothiazide in whites, and NEDD4L rs4149601 may be a predictor for adverse cardiovascular outcomes in whites not treated with hydrochlorothiazide. PMID:23353631

  3. Relationship between Proton Magnetic Resonance Spectroscopy of Frontoinsular Gray Matter and Neurodevelopmental Outcomes in Very Low Birth Weight Children at the Age of 4

    Science.gov (United States)

    Herman-Sucharska, Izabela; Urbanik, Andrzej; Klimek, Małgorzata; Karcz, Paulina; Dutkowska, Grażyna; Nitecka, Magdalena; Kwinta, Przemko

    2016-01-01

    Very low birth weight is associated with long term neurodevelopmental complications. Macroscopic brain abnormalities in prematurity survivors have been investigated in several studies. However, there is limited data regarding local cerebral metabolic status and neurodevelopmental outcomes. The purpose of this study was to characterize the relationship between proton magnetic resonance spectra in basal ganglia, frontal white matter and frontoinsular gray matter, neurodevelopmental outcomes assessed with the Leiter scale and the Developmental Test of Visual Perception and selected socioeconomic variables in a cohort of very low birth weight children at the age of four. Children were divided in three groups based on the severity of neurodevelopmental impairment. There were no differences in spectroscopy in basal ganglia and frontal white matter between the groups. Lower concentrations of N-acetylaspartate (NAA), choline (Cho) and myoinositol (mI) were observed in the frontoinsular cortex of the left hemisphere in children with neurodevelopmental impairment compared to children with normal neurodevelopmental outcomes. Higher parental education, daycare attendance and breastfeeding after birth were associated with more favorable neurodevelopmental prognosis, whereas rural residence was more prevalent in children with moderate and severe impairment. Our study demonstrates the role of long term neurometabolic disruption in the left frontoinsular cortex and selected socioeconomic variables in determination of neurodevelopmental prognosis in prematurity survivors. PMID:27223474

  4. Relationship between Proton Magnetic Resonance Spectroscopy of Frontoinsular Gray Matter and Neurodevelopmental Outcomes in Very Low Birth Weight Children at the Age of 4.

    Directory of Open Access Journals (Sweden)

    Wojciech Durlak

    Full Text Available Very low birth weight is associated with long term neurodevelopmental complications. Macroscopic brain abnormalities in prematurity survivors have been investigated in several studies. However, there is limited data regarding local cerebral metabolic status and neurodevelopmental outcomes. The purpose of this study was to characterize the relationship between proton magnetic resonance spectra in basal ganglia, frontal white matter and frontoinsular gray matter, neurodevelopmental outcomes assessed with the Leiter scale and the Developmental Test of Visual Perception and selected socioeconomic variables in a cohort of very low birth weight children at the age of four. Children were divided in three groups based on the severity of neurodevelopmental impairment. There were no differences in spectroscopy in basal ganglia and frontal white matter between the groups. Lower concentrations of N-acetylaspartate (NAA, choline (Cho and myoinositol (mI were observed in the frontoinsular cortex of the left hemisphere in children with neurodevelopmental impairment compared to children with normal neurodevelopmental outcomes. Higher parental education, daycare attendance and breastfeeding after birth were associated with more favorable neurodevelopmental prognosis, whereas rural residence was more prevalent in children with moderate and severe impairment. Our study demonstrates the role of long term neurometabolic disruption in the left frontoinsular cortex and selected socioeconomic variables in determination of neurodevelopmental prognosis in prematurity survivors.

  5. Birth in Brazil: national survey into labour and birth

    Directory of Open Access Journals (Sweden)

    do Carmo Leal Maria

    2012-08-01

    Full Text Available Abstract Background Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction. Methods Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients’ medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson’s groups. Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design. Discussion This study, for the first time, depicts a national panorama of labour and birth

  6. Risk of Performance Decrements and Adverse Health Outcomes Resulting from Sleep Loss, Circadian Desynchronization, and Work Overload

    Science.gov (United States)

    Flynn-Evans, Erin; Gregory, Kevin; Arsintescu, Lucia; Whitmire, Alexandra

    2016-01-01

    Sleep loss, circadian desynchronization, and work overload occur to some extent for ground and flight crews, prior to and during spaceflight missions. Ground evidence indicates that such risk factors may lead to performance decrements and adverse health outcomes, which could potentially compromise mission objectives. Efforts are needed to identify the environmental and mission conditions that interfere with sleep and circadian alignment, as well as individual differences in vulnerability and resiliency to sleep loss and circadian desynchronization. Specifically, this report highlights a collection of new evidence to better characterize the risk and reveals new gaps in this risk as follows: Sleep loss is apparent during spaceflight. Astronauts consistently average less sleep during spaceflight relative to on the ground. The causes of this sleep loss remain unknown, however ground-based evidence suggests that the sleep duration of astronauts is likely to lead to performance impairment and short and long-term health consequences. Further research is needed in this area in order to develop screening tools to assess individual astronaut sleep need in order to quantify the magnitude of sleep loss during spaceflight; current and planned efforts in BHP's research portfolio address this need. In addition, it is still unclear whether the conditions of spaceflight environment lead to sleep loss or whether other factors, such as work overload lead to the reduced sleep duration. Future data mining efforts and continued data collection on the ISS will help to further characterize factors contributing to sleep loss. Sleep inertia has not been evaluated during spaceflight. Ground-based studies confirm that it takes two to four hours to achieve optimal performance after waking from a sleep episode. Sleep inertia has been associated with increased accidents and reduced performance in operational environments. Sleep inertia poses considerable risk during spaceflight when emergency

  7. 自然妊娠和辅助生殖技术妊娠母婴不良结局及其危险因素分析%Adverse Outcomes and Risk Factors of Maternal and Child Out-comes in Natural Pregnancy and Assisted Reproductive Technology

    Institute of Scientific and Technical Information of China (English)

    杨昱; 钟群英

    2016-01-01

    Objective To compare the adverse outcome of natural pregnancy and maternal reproduc-tive technology assisted (ART) pregnancy and its risk factors, so as to provide basis for the pre-vention of adverse outcome. Methods 100 ART pregnant women who had antenatal examination in our hospital and had follow up till the childbirth from April, 2014 to April, 2015 were ran-domly selected as ART group, and other 500 natural pregnancy pregnant women in the same pe-riod were selected as controls. Maternal adverse outcome and its risk factors of two groups were compared. Results Premature birth, abortion, cesarean section and other adverse pregnancy out-come incidence of ART group (87.0%) are higher than that of the control group (59.2%) (P<0.05). Single factor analysis results showed that multiple pregnancy, age, gestational diabetes mellitus (GDM), body mass index (BMI), abortion history were related factor of adverse pregnancy outcome of ART pregnancy,and age, pregnancy hypertension, GDM, BMI, history of abortion were related factor of natural maternal (P<0.05 or P<0.01). Further Logistic multivariate regression analysis re-sults showed that age, GDM, history of abortion, pregnancy hypertension and age, history of GDM, abortion, multiple pregnancies were risk factors of respectively adverse outcome of natural maternal pregnancy and ART pregnancy (P<0.05 or P<0.01). Conclusions Incidence of maternal adverse pregnancy outcome of ART pregnant women is highand related to age, GDM, history of abortion and multiple pregnancies,and adverse pregnancy outcome of natural pregnancy is related to age, GDM, history of abortion and pregnancy hypertension. According to the different risk factors ad-verse pregnancy outcomes to adopt appropriate intervention, avoiding older pregnancy or abortion, active prevention and treatment of GDM and management of multiple births as early as possible can help to improve the ART pregnancy outcomes.%目的:探讨自然妊娠和辅助生殖技术(ART

  8. The incidence, root-causes, and outcomes of adverse events in surgical units: implications for potential prevention strategies.

    NARCIS (Netherlands)

    Zegers, M.; Bruijne, M.C. de; Keizer, B. de; Merten, H.; Groenewegen, P.P.; Wal, G. van der

    2011-01-01

    Background: We need to know the scale and underlying causes of surgical adverse events (AEs) in order to improve the safety of care in surgical units. However, there is little recent data. Previous record review studies that reported on surgical AEs in detail are now more than ten years old. Since t

  9. The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies.

    NARCIS (Netherlands)

    Zegers, M.; Bruijne, M.C. de; Keizer, B. de; Merten, H.; Groenewegen, P.P.; Wal, G. van der; Wagner, C.

    2011-01-01

    Background: We need to know the scale and underlying causes of surgical adverse events (AEs) in order to improve the safety of care in surgical units. However, there is little recent data. Previous record review studies that reported on surgical AEs in detail are now more than ten years old. Since t

  10. Drinking Before Going to Licensed Premises: An Event-Level Analysis of Predrinking, Alcohol Consumption, and Adverse Outcomes

    NARCIS (Netherlands)

    Labhart, F.; Graham, K.; Wells, S.; Kuntsche, E.N.

    2013-01-01

    Background Research in the United States and the United Kingdom indicates that drinking before going out (commonly called predrinking) is common among young people and associated with increased harm. On the basis of Swiss data, this study investigates differences in alcohol consumption and adverse o

  11. Development and application of the adverse outcome pathway framework for understanding and predicting chronic toxicity: I. Challenges and research needs in ecotoxicology.

    Science.gov (United States)

    Groh, Ksenia J; Carvalho, Raquel N; Chipman, James K; Denslow, Nancy D; Halder, Marlies; Murphy, Cheryl A; Roelofs, Dick; Rolaki, Alexandra; Schirmer, Kristin; Watanabe, Karen H

    2015-02-01

    To elucidate the effects of chemicals on populations of different species in the environment, efficient testing and modeling approaches are needed that consider multiple stressors and allow reliable extrapolation of responses across species. An adverse outcome pathway (AOP) is a concept that provides a framework for organizing knowledge about the progression of toxicity events across scales of biological organization that lead to adverse outcomes relevant for risk assessment. In this paper, we focus on exploring how the AOP concept can be used to guide research aimed at improving both our understanding of chronic toxicity, including delayed toxicity as well as epigenetic and transgenerational effects of chemicals, and our ability to predict adverse outcomes. A better understanding of the influence of subtle toxicity on individual and population fitness would support a broader integration of sublethal endpoints into risk assessment frameworks. Detailed mechanistic knowledge would facilitate the development of alternative testing methods as well as help prioritize higher tier toxicity testing. We argue that targeted development of AOPs supports both of these aspects by promoting the elucidation of molecular mechanisms and their contribution to relevant toxicity outcomes across biological scales. We further discuss information requirements and challenges in application of AOPs for chemical- and site-specific risk assessment and for extrapolation across species. We provide recommendations for potential extension of the AOP framework to incorporate information on exposure, toxicokinetics and situation-specific ecological contexts, and discuss common interfaces that can be employed to couple AOPs with computational modeling approaches and with evolutionary life history theory. The extended AOP framework can serve as a venue for integration of knowledge derived from various sources, including empirical data as well as molecular, quantitative and evolutionary-based models

  12. Overweight, obesity and underweight is associated with adverse psychosocial and physical health outcomes among 7-year-old children: the 'Be active, eat right' study.

    Directory of Open Access Journals (Sweden)

    Amy van Grieken

    Full Text Available BACKGROUND: Limited studies have reported on associations between overweight, and physical and psychosocial health outcomes among younger children. This study evaluates associations between overweight, obesity and underweight in 5-year-old children, and parent-reported health outcomes at age 7 years. METHODS: Data were used from the 'Be active, eat right' study. Height and weight were measured at 5 and 7 years. Parents reported on child physical and psychosocial health outcomes (e.g. respiratory symptoms, general health, happiness, insecurity and adverse treatment. Regression models, adjusted for potential confounders, were fitted to predict health outcomes at age 7 years. RESULTS: The baseline study sample consisted of 2,372 children mean age 5.8 (SD 0.4 years; 6.2% overweight, 1.6% obese and 15.0% underweight. Based on parent-report, overweight, obese and underweight children had an odds ratio (OR of 5.70 (95% CI: 4.10 to 7.92, 35.34 (95% CI: 19.16; 65.17 and 1.39 (95% CI: 1.05