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The prenatal environment is now recognized as a key driver of non-communicable disease risk later in life. Within the developmental origins of health and disease (DOHaD) paradigm, studies are increasingly identifying links between maternal morbidity during pregnancy and disease later in life for offspring. Nutrient restriction, metabolic disorders during gestation, such as diabetes or obesity, and maternal immune activation provoked by infection have been linked to adverse health outcomes for offspring later in life. These factors frequently co-occur, but the potential for compounding effects of multiple morbidities on DOHaD-related outcomes has not received adequate attention. This is of particular importance in low- or middle-income countries (LMICs), which have ongoing high rates of infectious diseases and are now experiencing transitions from undernutrition to excess adiposity. The purpose of this scoping review is to summarize studies examining the effect and interaction of co-occurring metabolic or nutritional stressors and infectious diseases during gestation on DOHaD-related health outcomes. We identified nine studies in humans - four performed in the United States and five in LMICs. The most common outcome, also in seven of nine studies, was premature birth or low birth weight. We identified nine animal studies, six in mice, two in rats and one in sheep. The interaction between metabolic/nutritional exposures and infectious exposures had varying effects including synergism, inhibition and independent actions. No human studies were specifically designed to assess the interaction of metabolic/nutritional exposures and infectious diseases. Future studies of neonatal outcomes should measure these exposures and explicitly examine their concerted effect.
OBJECTIVE - The purpose of this study was to describe antidepressant medication use patterns during pregnancy and pregnancy outcomes.
STUDY DESIGN - We evaluated a cohort of 228,876 singleton pregnancies that were covered by Tennessee Medicaid, 1995-2007.
RESULTS - Of 23,280 pregnant women with antidepressant prescriptions before pregnancy, 75% of them filled none in the second or third trimesters of pregnancy, and 10.7% of them used antidepressants throughout pregnancy. Filling 1, 2, and ≥3 antidepressant prescriptions during the second trimester was associated with shortened gestational age by 1.7 (95% confidence interval [CI], 1.2-2.3), 3.7 (95% CI, 2.8-4.6), and 4.9 (95% CI, 3.9-5.8) days, when controlled for measured confounders. Third-trimester selective serotonin reuptake inhibitor use was associated with infant convulsions; adjusted odds ratios were 1.4 (95% CI, 0.7-2.8); 2.8 (95% CI, 1.9-5.5); and 4.9 (95% CI, 2.6-9.5) for filling 1, 2, and ≥3 prescriptions, respectively.
CONCLUSION - Most women discontinue antidepressant medications before or during the first trimester of pregnancy. Second-trimester antidepressant use is associated with preterm birth, and third-trimester selective serotonin reuptake inhibitor use is associated with infant convulsions.
Copyright © 2012 Mosby, Inc. All rights reserved.
OBJECTIVE - To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy.
DESIGN - Cross-sectional study.ParticipantsFive hundred and forty mother-infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW.
RESULTS - Of 540 infants, 100 (18.5 %) weighed
208.7 mg/d), infants of mothers with MUAC less than or equal to the median and dietary vitamin C intake >208.7 mg/d (adjPR = 10.80; 95 % CI 1.46, 79.76), mothers with MUAC above the median and vitamin C intake CONCLUSIONS - In Pakistan, poor nutritional status and inadequate prenatal care were major determinants of LBW in this setting. Environmental factors including umbilical cord BLL were not significantly associated with LBW.
The morphological findings of so-called hypertensive nephrosclerosis, rather than implying a linear direct relationship to damage induced by hypertension, may indicate complex environmental and genetic factors, which together foster the coexistence of renal lesion and hypertension in this clinical setting. We discuss the clinical and pathological criteria for diagnosis of arterionephrosclerosis, and possible pathogenetic factors, including hypertension, ethnicity, aberrant autoregulation, prothrombotic mechanisms, low birth weight, decreased nephron number, genetic factors and dysmetabolic syndrome.
The purpose of this cross-sectional study was to investigate the association between partner physical or emotional abuse during pregnancy and pregnancy outcomes including perinatal death, low birthweight and preterm delivery. Women, aged 18-65, who attended one of two large primary care practices from 1997-98 were recruited for this study. Ever pregnant women were asked the frequency of abuse during each pregnancy and details of the pregnancy outcomes. Information regarding abuse during pregnancy and pregnancy outcomes was available for 755 women surveyed who reported a live birth or late fetal death, 14.7% indicated that an intimate partner was violent or abusive toward them during a pregnancy (274 of 1862 pregnancies). Abuse during pregnancy was significantly associated with an increased risk of perinatal death (adjusted relative risk [aRR] = 2.1, 95% confidence interval [CI] 1.3, 3.4) and, among live births, with preterm low birthweight (aRR = 2.4; 95% CI 1.5, 4.0) and term low birthweight (aRR = 1.9; 95% CI 1.0, 3.4). Greater abuse frequency was associated with increased risk. Abuse during pregnancy was associated with perinatal deaths and preterm low birthweight deliveries.
BACKGROUND - Low birthweight (BW) and childhood growth have been hypothesized to be associated with an increased risk of hypertension in later life.
METHODS - We analysed data among 13,467 women with a recalled BW from the Shanghai Women's Health Study. Cases included those with a self-reported hypertension with ('confirmed cases') or without ('possible cases') antihypertensive medication(s) use. Logistic regression was used to derive adjusted odds ratios (OR) and 95% CI.
RESULTS - Birthweight was inversely associated with the odds of early onset (at age 20-40 years) hypertension in a dose response manner (P for trend = 0.01). This association is stronger for 'confirmed' hypertension (only OR for 'confirmed' hypertension are referred to subsequently). Being heavier or taller than average at 15 years of age were both related to elevated odds of early onset hypertension. Women who had a low BW but were heavier than average at age 15 were more than four times (OR = 4.63, 95% CI: 2.40-8.94) more likely to have an early onset hypertension, and those who had a low BW and became taller at 15 years of age had an OR of 1.87 (95% CI: 1.05-3.31). A significant interaction between BW and weight at age 15 was observed (P = 0.04).
CONCLUSION - Our study suggests that low BW, particularly if accompanied by accelerated childhood growth, may increase the risk of early onset hypertension in adulthood.
OBJECTIVES - The 1988 National Maternal and Infant Health Survey (NMIHS) was conducted by the National Center for Health Statistics to study factors related to poor pregnancy outcome, such as adequacy of prenatal care; inadequate and excessive weight gain during pregnancy; maternal smoking, drinking, and drug use; and pregnancy and delivery complications.
METHODS - The NMIHS is a nationally representative sample of 11,000 women who had live births, 4,000 who had late fetal deaths, and 6,000 who had infant deaths in 1988. Questionnaires were mailed to mothers based on information from certificates of live birth, reports of fetal death, and certificates of infant death. Information supplied by the mother, prenatal care providers, and hospitals of delivery was linked with the vital records to expand knowledge of maternal and infant health in the United States.
RESULTS - The response rates in all three components of the NMIHS differed according to the mothers' characteristics. Mothers were more likely to respond if they were 20-39 years of age, were white, were married, had fewer than four children, entered prenatal care early, had more prenatal visits, had more years of education, or resided in the Midwest Region. The percent of respondents was lower for teenage mothers, mothers of races other than white, and mothers with four or more children, little prenatal care, or fewer years of education. Mothers whose infants weighed less than 2,500 grams were less likely to respond in the live-birth and infant-death components than mothers whose infants weighed 2,500 grams or more.
CONCLUSIONS - The NMIHS will provide an invaluable tool for researchers and practitioners seeking solutions to perinatal and obstetric problems.
The relationship between the birthweight of white and black mothers and the outcomes of their infants were examined using the 1988 National Maternal and Infant Health Survey. White and black women who were low birthweight themselves were at increased risk of delivering very low birthweight (VLBW), moderately low birthweight (MLBW), extremely preterm and small size for gestational age (SGA) infants. Adjustment for the confounding effects of prepregnant weight and height reduced the risks of all these outcomes slightly, and more substantially reduced the maternal birthweight associated risk of moderately low birthweight among white mothers. There was little effect of maternal birthweight on infant birthweight-specific infant mortality in white mothers; however, black mothers who weighed less than 4 lbs at birth were at significantly increased risk of delivering a normal birthweight infant who subsequently died. Although the risks for the various outcomes associated with low maternal birthweight were not consistently higher in black mothers compared with white mothers, adjustment for prepregnant weight and height had a greater effect in white mothers than in black mothers. We suggest that interventions to reduce the risks for adverse pregnancy outcomes associated with low maternal birthweight should attempt to optimise prepregnant weight and foster child health and growth.
OBJECTIVES - "Presumptive eligibility" permits pregnant prospective Medicaid enrollees to obtain services during the application period. The purpose of this study was to assess the effects of presumptive eligibility on the receipt of prenatal care and the occurrence of low-birthweight births and neonatal, perinatal, and infant mortality.
METHODS - Outcome rates for pregnant women who enrolled in Tennessee Medicaid in the 6-month period before presumptive eligibility was enacted were compared with those obtained for pregnant women who enrolled in the 6-month period after presumptive eligibility had been in effect for 5 months.
RESULTS - Women in the "after" group were 40% more likely to enroll and 30% more likely to obtain prenatal care in the first trimester. They were 300% more likely to fill a prescription for prenatal vitamins in the first trimester and 16% more likely to have begun prenatal care before the third trimester. However, they were similar to those enrolling in the "before" time period in terms of the occurrence of adverse perinatal outcomes.
CONCLUSIONS - When barriers to prenatal care, including bureaucratic ones, are removed, low-income women will seek care earlier and more frequently.