Perinatal mortality and adverse pregnancy outcomes in a low‐income rural population of women who smoke

We describe adverse pregnancy outcomes, including congenital anomalies, fetal, neonatal, and infant mortality among a Missouri population of low‐income, rural mothers who participated in two randomized smoking cessation trials. In the Baby BEEP (BB) trial, 695 rural women were recruited from 21 WIC clinics with 650 women's pregnancy outcomes known (93.5% retention rate). Following the BB trial, 298 women who had a live infant after November 2004 were recruited again into and completed the Baby Beep for Kids (BBK) trial. Simple statistics describing the population and perinatal and postneonatal mortality rates were calculated. Of the adverse pregnancy outcomes (n = 79), 29% were spontaneous abortions of less than 20 weeks' gestation, 23% were premature births, and 49% were identified birth defects. The perinatal mortality rate was 15.9 per 1000 births (BB study) compared with 8.6 per 1000 births (state of Missouri) and 8.5 per 1000 births (United States). The postneonatal infant mortality rate was 13.4 per 1000 live births (BBK) compared with 2.1 per 1000 live births (United States). The health disparity in this population of impoverished, rural, pregnant women who smoke, particularly in regard to perinatal and infant deaths, warrants attention. Birth Defects Research (Part A), 2012. © 2012 Wiley Periodicals, Inc.     

Pre-existing diabetes mellitus and adverse pregnancy outcomes

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 T1DM and 50 (43%) women with T2DM. Compared to non-diabetic women those with PGMD 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 < 0.001, or elective C/S, OR 6.73, 95% CI (3.99-11.31), P < 0.001. The neonates of the mothers with PDM were significantly heavier, P < 0.001; and more frequently macrosomic; OR 3.97, 95% CI (2.03-7.65), P = 0.002. They more frequently have APGAR scores <7 in 5 minutes, OR 2.61, 95% CI (0.89-7.05), P 0.057 and more likely to be delivered at <37 gestation weeks, OR 2.24, 95% CI (1.37- 3.67), P 0.003. The stillbirth rate was 2.6 times more among the women with PDM group; 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.     

妊娠中晚期孕妇阴道菌群紊乱的改变对不良妊娠结局的影响

目的探讨妊娠中晚期孕妇阴道菌群紊乱的改变对不良妊娠结局的影响。方法选取产科门诊就诊的妊娠28-34周的患者150例。根据检查结果将其分为菌群正常组48例和菌群失常组102例。观察并对比两组患者的不良妊娠结局。结果 102例菌群失常患者中滴虫6例,假丝酵母菌67例,衣原体17例,淋菌2例,细菌性阴道病10例。假丝酵母菌感染率明显高于其他致病菌(P0.05)。菌群失常组患者早产、胎膜早破、剖宫产、产褥感染发生率分别为15.69%、22.55%、35.29%和18.63%,均明显高于菌群正常组的4.17%、8.33%、18.75%和6.25%(P0.05)。菌群失常组患者新生儿黄疽、新生儿感染和低出生体重儿发生率分别为24.51%、21.57%、16.67%,均明显高于菌群正常组的10.42%、8.33%、4.17%(P0.05),在胎儿窘迫的发生率方面两组比较差异无统计学意义(P0.05)。结论妊娠中晚期阴道菌群紊乱中以假丝酵母菌感染发生率最多,与不良妊娠结局密切相关,增加了早产、胎膜早破、剖宫产、产褥感染、新生儿黄疸、新生儿感染和低出生体重儿等与不良妊娠结局的发生率。     

阴道微生态与围产期不良结局的研究进展

阴道微生态对围产期结局的影响已成为近期医学研究的焦点。阴道内定植有多种微生物,其中优势菌为乳杆菌,维持着阴道内正常pH。当机体免疫防御能力降低或者内分泌系统紊乱时,机会致病菌占据优势,极易诱发阴道炎性病变,严重影响妊娠期女性正常生活,并且对胎儿的发育及健康成长造成威胁,导致早产和胎膜早破等不良妊娠结局的发生。由于阴道菌群毒力强弱具有差异性,感染所致的阴道炎性疾病容易复发且不易根除,因此在治疗方面,临床医师需要根据个体化原则指导用药。本文对近年来阴道微生态与妊娠不良结局的相关性研究进行简要综述。     

肠道菌群与妊娠期甲状腺疾病患者的常见不良妊娠结局

目前, 肠道菌群被认为是影响机体内环境的潜在因素, 一旦失调, 可能导致多系统的疾病。妊娠期妇女由于机体代谢及免疫状态的变化, 是罹患妊娠期甲状腺疾病的高危人群。而妊娠期甲状腺疾病可导致流产、早产和出生体质量过低等常见不良妊娠结局, 对产妇、新生儿及其家庭造成十分恶劣的影响。妊娠期妇女作为特殊群体, 其肠道菌群的研究备受关注, 但目前关于妊娠期甲状腺疾病的肠道菌群研究仍较少。为更好地指导临床以及寻求改善妊娠期甲状腺疾病患者常见不良妊娠结局, 本文对肠道菌群与妊娠期甲状腺疾病患者的常见不良妊娠结局的相关研究进行综述。

     

Simple sleep questions can predict 12-year mortality in a rural population

Sleep and Biological Rhythms - There is apt evidence in favor of a significant association between sleep and mortality. So far, most studies examine sleep problems using comprehensive,...     

妊娠期妇女生殖道大肠埃希菌感染与妊娠不良结局分析

目的探讨妊娠期妇女生殖道大肠埃希菌感染对妊娠不良结局的影响。方法回顾性分析2011年1月至2013年12月在石家庄市第四医院住院孕产妇共2 053例,进行阴道分泌物细菌培养,对大肠埃希菌培养阳性组与正常对照组的妊娠结局进行分析,以探讨妊娠合并生殖道大肠埃希菌感染与围产期并发症的关系。结果在2 053例围产期妇女中,无致病菌组（对照组）为1230例,大肠埃希菌培养阳性组（感染组）为103例,总患病率为5.02%。感染组与对照组的绒毛膜羊膜炎的发生率分别为78.64%、12.20%（P〈0.01）,产褥感染率分别为24.27%、3.41%（P〈0.01）,新生儿黄疸的发生率58.25%、12.36%（P〈0.01）,胎膜早破率分别为11.65%、10.57%（P〉0.05）,早产率分别为3.88%、3.09%（P〉0.05）,胎儿窘迫的发生率2.91%、2.76%（P〉0.05）,低体重儿的发生率1.94%、2.03%（P〉0.05）。结论妊娠期妇女生殖道大肠埃希菌感染与绒毛膜羊膜炎、产褥感染及新生儿黄疸的发生相关,孕期及早发现、诊断、治疗妊娠期妇女生殖道大肠埃希菌感染是有重要意义。     

Selection intensities in menopausal and permanent contraceptor women of a rural population in India

Abstract

The opportunity for selection was estimated in the rural population of Visakhapat‐nam District, Andhra Pradesh, India. The index of total selection was found to be low. Selection in relation to birth control reveals that opportunity for selection is lower among the women who completed their fertility by family planning methods than in women who completed their fertility by attaining menopause. Further, the results showed that differential fertility and mortality make equal contributions to the total measure of selection in both groups.     

Selection intensities in menopausal and permanent contraceptor women of a rural population in India

Changing fertility and mortality patterns due to socioeconomic forces have a profound effect on natural selection in human populations. The opportunity for selection was estimated in the rural population of Visakhapatnam District, Andra Pradesh, India, in 1979. A total of 1570 women were interviewed, 1544 among them had ever been pregnant. Data were analyzed to compute fertility and mortality components of the population. The index of total selection was found to be low. Selection in relation to birth control reveals that opportunity for selection is lower among women who completed their fertility by family planning methods than in women who completed their fertility by attaining menopause. Further, the results showed that differential fertility and mortality make equal contributions to the total measure of selection in both groups, whereas in developed countries like the US the mortality component contributes only a small fraction to the total index, due to improved health conditions.     

Zika-related adverse outcomes in a cohort of pregnant women with rash in Pernambuco,Brazil

BackgroundWhile Zika virus (ZIKV) is now widely recognized as a teratogen, the frequency and full spectrum of adverse outcomes of congenital ZIKV infection remains incompletely understood.MethodsParticipants in the MERG cohort of pregnant women with rash, recruited from the surveillance system from December/2015-June/2017. Exposure definition was based on a combination of longitudinal data from molecular, serologic (IgM and IgG3) and plaque reduction neutralization tests for ZIKV. Children were evaluated by a team of clinical specialists and by transfontanelle ultrasound and were classified as having microcephaly and/or other signs/symptoms consistent with congenital Zika syndrome (CZS). Risks of adverse outcomes were quantified according to the relative evidence of a ZIKV infection in pregnancy.Findings376 women had confirmed and suspected exposure to ZIKV. Among evaluable children born to these mothers, 20% presented with an adverse outcome compatible with exposure to ZIKV during pregnancy. The absolute risk of microcephaly was 2.9% (11/376), of calcifications and/or ventriculomegaly was 7.2% (13/180), of additional neurologic alterations was 5.3% (13/245), of ophthalmologic abnormalities was 7% (15/214), and of dysphagia was 1.8% (4/226). Less than 1% of the children experienced abnormalities across all of the domains simultaneously. Interpretation: Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination. Due to the rare nature of some outcomes and the possibility of later manifestations, large scale individual participant data meta-analysis and the long-term evaluation of children are imperative to identify the full spectrum of this syndrome and to plan actions to reduce damages.     

Maternal exposure to folic acid antagonists and placenta-mediated adverse pregnancy outcomes

Background

In previous studies, maternal exposure to folic acid antagonists was associated with increased risks of neural tube defects, cardiovascular defects, oral clefts and urinary tract defects. The objective of the current study was to assess the possible effects of using folic acid antagonists in pregnancy on placenta-mediated adverse outcomes of pregnancy.

Methods

We used data from an administrative database to retrospectively compare the occurrence of placenta-mediated adverse pregnancy outcomes between pregnant women exposed to folic acid antagonists and women without exposure to these agents.

Results

We included in the analysis a total of 14 982 women who had been exposed to folic acid antagonists and 59 825 women who had not been exposed. Sulfamethoxazole–trimethoprim was the most frequently prescribed dihydrofolate reductase inhibitor (a total of 12 546 exposures during the preconception period and all 3 trimesters), and phenobarbital was the most frequently prescribed among the other folic acid antagonists (a total of 1565 exposures). The risks of preeclampsia (adjusted odds ratio [OR] 1.52, 95% confidence interval [CI] 1.39–1.66), severe preeclampsia (OR 1.77, 95% CI 1.38–2.28), placental abruption (OR 1.32, 95% CI 1.12–1.57), fetal growth restriction defined as less than the 10th percentile (OR 1.07, 95% CI 1.01–1.13), fetal growth restriction defined as less than the 3rd percentile (OR 1.22, 95% CI 1.11–1.34) and fetal death (OR 1.35, 95% CI 1.07–1.70) were greater among mothers with exposure to folic acid antagonists. In general, the risks associated with exposure to other folic acid antagonists were higher than those associated with exposure to dihydrofolate reductase inhibitors. Supplementary analyses involving tight matching with propensity score, restriction of the analysis to women with exposure during the first and second trimesters and restriction of the analysis to specific categories of folic acid antagonists yielded similar results.

Interpretation

Maternal exposure to folic acid antagonists appears to increase the risk of placenta-mediated adverse outcomes of pregnancy.     

Differential sex mortality in a rural nineteenth-century population: Escazu, Costa Rica.

Cross-cultural studies of sex-specific mortality indicate that, whereas males experience their greatest mortality in industrialized societies, females experience their greatest mortality in populations with low life expectancy. The higher mortality of females in low-life-expectancy communities has been interpreted as a reflection of nutritional and health-care discrimination against females. Cross-cultural demographic studies also indicate that males have a higher frequency of violent and accidental deaths, possibly because of more frequent risky behaviors. This study focuses on Escazu, a rural nineteenth-century population from Costa Rica with low life expectancy. I investigate whether Escazu males had higher violent and accidental deaths and whether females had higher diarrhea-related deaths, an indication of nutritional discrimination. An analysis of mortality by cause of death indicates that males and females did not experience significantly different diarrhea-related death rates, although males did experience greater violent mortality. This study illustrates that more anthropological community-specific studies of mortality are needed to elucidate variation of death rates within large national or international regions.     

Perinatal mortality and sex ratios in Hawaii

Retrospective data obtained from a sample of 926 mothers of European ancestry (AEA) and 368 mothers of Japanese ancestry (AJA) living in Hawaii were used to evaluate two hypotheses, the selective male affliction hypothesis and the Trivers-Willard female condition hypothesis, for male-biased perinatal mortality and altered sex ratio at birth. Logit analyses using pregnancy outcome (live-birth versus stillbirth or miscarriage) as the dependent variable and either sex of prior sib, sex of offspring, parity, age of mother, or interval since last pregnacy as independent variables did not support either hypothesis. In contrast to the prediction of the selective male affliction model, sex of previous pregnancy was not related to perinatal mortality. Although each of the other independent variables exerted significant effects on perinatal mortality and, therefore, presumably affected female condition, in no case did natal sex ratios become female-biased. The Trivers-Willard hypothesis predicts that female-biased sex ratios are expected when female condition is reduced. The results are discussed in relation to the possibility that degree of sexual dimorphism may favor male-biased perinatal mortality and explains the observed decline in sex ratio with parity.     

妊娠中晚期阴道微生态失调及乳酸菌胶囊干预对不良妊娠结局的作用

目的 观察妊娠中晚期妇女阴道微生态状况,探讨应用乳杆菌活菌胶囊纠正阴道微生态失调对不良妊娠结局的预防价值。方法 选择孕13~36周单胎妊娠期妇女560例,取其阴道分泌物,经革兰染色后油镜下观察,进行阴道微生态（阴道菌群的密集度、多样性、优势菌、炎症反应等）状况评价,检测阴道分泌物成分、阴道病原菌类型。对阴道微生态失调孕妇,根据是否接受乳杆菌活菌胶囊治疗分为治疗组和对照组,治疗组给予乳杆菌活菌胶囊,对照组不采用药物干预。追踪随访所有孕妇的妊娠情况,比较阴道微生态正常组、微生态失调治疗组及微生态失调对照组的不良妊娠结局。结果 560例研究对象中,阴道微生态正常 335 例（59.82%）,微生态失调225例（40.18%）。225例微生态失调孕妇中,细菌性阴道病（bacterial vaginosis,BV）32例（14.22%）,阴道假丝酵母菌病（vulvovaginal candidiasis,VVC）56例（24.89%）,滴虫性阴道炎（triehomonal vaginitis,TV）11例（4.89%）,BV和VVC混合感染4例（1.78%）,BV和TV混合感染3例（1.33%）,菌群增殖过度75例（33.33%）,菌群抑制44例（19.56%）。微生态失调组pH值>4.5、过氧化氢、白细胞酯酶、唾液酸苷酶、脯氨酸氨基肽酶、乙酰氨基葡萄糖苷酶阳性比例均明显高于微生态正常组（χ2=55.59~340.06,Ps0.05）。结论 妊娠中晚期容易导致阴道微生态失调,造成不良妊娠结局,乳杆菌活菌胶囊纠正阴道微生态失调对于改善不良妊娠结局有较好的预防作用。