Maternal outcomes among HIV positive pregnant mothers and birth outcomes of HIV exposed newborns in Nyahururu County Referral Hospital, Kenya

Background Approximately 37 million people were living with HIV by the end of 2015. This led to high morbidity and mortality among women of childbearing age, especially in SubSaharan Africa which was the epicentre of this global pandemic. Strengthening and implementing prevention of mother-to-child (PMTCT) services could reduce the incidence of vertical transmission and improve quality of life. We aimed to determine maternal and birth outcomes among HIV-positive pregnant mothers and HIV-exposed newborns in Nyahururu county referral hospital, Laikipia, Kenya. Main Outcomes Measures Reduce maternal morbidity and mortality and other birth-related complications. In addition, this will also reduce infant mortality and morbidity among HIV-exposed infants. Materials And Methods This was a hospital-based descriptive prospective study conducted at the PMTCT department at the Nyahururu County referral hospital. A sample of 180 HIV-positive pregnant women enrolled at the PMTCT consented to participate in the study. We monitored them until delivery and labour complications were addressed. Babies were scored against the APGAR scale, weighed and spot dried blood samples taken before breastfeeding; and started on prophylactic antiretroviral therapy. RESULTS Out of 180 participants, only 17 did not complete the study. Our findings indicate that 97.5 % of the mothers delivered in the hospital, had labour lasting less than 12 hours, 92.6% had a normal delivery and 94.9% had no complications during the labour period. About 2.5 % of the women had misoprostol administration. The majority of exposed babies had an average weight of between 2.51 - 3.00kg. No neonatal asphyxia was evident among exposed babies. Conclusions: The majority of the respondents delivered in the hospital; no neonatal asphyxia was evidenced and there was a significant correlation between APGAR scores and infant weight. There is a need for active follow-up and monitoring of HIV pregnant women and their unborn babies until delivery.

Knowledge of emergency preparedness among nurses in Machakos level five Hospital in Machakos County, Kenya

BACKGROUND An emergency is an unexpected event that disrupts normal operations within a health facility and requires immediate interventions to address it. Knowledge of emergency preparedness is an important role of clinical nursing to enhance patient outcomes. This study aimed to determine the types of emergencies received at Machakos Level 5 Hospital (ML5H) and to assess the nurses' level of knowledge on emergency preparedness. MATERIALS AND METHOD This was a descriptive cross-sectional research design. The study was conducted at Machakos Level 5 Hospital, Machakos County, Kenya. The sample included 132 nurses working at ML5H, who were randomly selected and consented to participate in the study. Data was collected using a self-administered questionnaire and an observation checklist. Data were coded and entered into SPSS version 25 software and the analysis included descriptive statistical tests. RESULTS A little more than a half (56%) of the nurses were found to have adequate knowledge of emergency preparedness; 65% had attended training on emergency preparedness and 63% indicated that training had enhanced their competence. CONCLUSION A higher proportion of nurses reported not participating in emergency drills that could be used to improve their knowledge and skills in emergency preparedness. The results of the study indicate that there is a need to enhance the knowledge of nurses' on emergency preparedness.

Association of socioeconomic status with adverse birth outcomes at the Women and Newborn Hospital of the University Teaching Hospitals in Lusaka, Zambia

Background: Low socioeconomic status has generally been associated with adverse birth outcomes worldwide. Adverse birth outcomes significantly contribute to perinatal morbidity and mortality worldwide with some literatures showing conflicting results. At Women and New-born Hospital in Zambia, this relationship had remained unclear among women who experienced poor neonatal outcome; hence the study was done to explore this association between socioeconomic status and adverse birth outcomes. Methods: A retrospective cohort study was conducted. Secondary data from ZAPPS study that had been collected prospectively between August 2015 and September 201 7 was retrieved. Altogether, 1,450 participants' information was retrieved, out of which 1,084 data records were set out for analysis after excluding those not meeting eligibility criteria. Socioeconomic status was an explanatory variable which was estimated using the standardized wealth score derived from principal component analysis of 14 variables. The wealth quintiles were further categorised into poor and not poor. Response variables were low birth weight, preterm birth and small for gestation age. SPSS version 21 was used for data analysis and p value< 0.05 was significant Results: This study found the incidences of SGA, LBW and preterm births to be 164, 124 and 13 5 per 1000 live births respectively. In survival analysis, the proportion of babies who survived LBW among mothers who were poor was lower (82.9%) compared to babies born to rich mothers (87.5%) (p-value = 0.189). Furthermore, the proportion of babies who survived SGA for the poor was lower (79 .1 % ) compared to babies born to none poor mothers (85.8%) (p-value = 0.032) and preterm birth for the poor (78.4%) compared to babies born to mothers who were rich (83 .6%) (p-value = 0.022). In multiple Cox regression analysis socioeconomic status was not a significant risk factor for SGA ( aHR = 1.08; 95% CI; p=0.099), LBW and preterm birth (aHR = 1.17; 95% CI; p= l.41). However, male babies (aHR = 1.80; 95% CI; p=0.012), domestic violence or abuse during pregnancy (aHR = 3.48; 95% CI [1.59 - 7.34]; p = 0.002) and maternal anaemia (aHR = 2.1; 95% CI; p = 0.019) were risk factors for SGA while prior preterm birth ( aHR = 2.02; 95% CI; p = 0.002), HIV infection (aHR = 1.22; 95% CI; p = 0.040) and anaemia (aHR = 1.37; 95% CI; p = 0.009) were predictors of preterm delivery. Conclusion: There was no statistically significant association between low socioeconomic status and adverse birth outcomes although being pregnant with a male baby, HIV infection, anaemia and prior preterm birth were significantly associated with SGAand preterm

Triclosan exposure to pregnant women and its association with birth outcomes / 上海预防医学

Triclosan(TCS)is a broad-spectrum antibacterial agent that is widely used in personal care products. Humans are exposed to these chemicals through oral intake or direct dermal absorption. The main way to eliminate TCS is through urine. Studies have shown that TCS may interfere with thyroid function and the reproductive endocrine system. In recent years, increasing epidemiological studies have focused on TCS exposure during pregnancy and the relationship between TCS exposure and birth outcomes. Compared with other countries and regions, pregnant women have lower levels of TCS exposure in China. Animal experiments suggested that high dose of TCS exposure during pregnancy may affect birth outcomes through its endocrine disruption. This review is aimed to summarize the effects of TCS exposure during pregnancy on the birth outcomes.

Study on the relationship of thallium exposure and outcomes of births / 中华流行病学杂志

Objective To investigate the relationship of thallium exposure and outcomes of births.Methods A total of 3 236 mothers who had visited in Ma'anshan Maternal and Child Health-Care Hospital between May 2013 and September 2014 were included in this study and their thallium concentrations measured from samples of maternal and umbilical cord blood by inductively coupled plasma mass spectrometry.The results were correlated and evaluated with birth outcomes of the infants,using the multiple linear regression method.Results The median (P25-P75) of thallium levels in first trimester,second trimester and umbilical cord blood were 61.7 (50.8-77.0),60.3 (50.8-75.2) and 38.5 (33.6-44.1) ng/L,respectively.After adjustment for potential confounders,the thallium levels showed an inversely significant association with birth head circumference (unstandardized β coefficient=-0.41,95％ CI:-0.76--0.06) in thc first trimester blood,and associated with reduced birth length (unstandardizedβ coefficient=-0.65,95％ CI:-1.25--0.05) in umbilical cord blood.However,there appeared no significantly associations with birth weight,length and head circumference (P＞0.05) in second trimester.On stratification by sex,in girls but not in boys,the thallium levels were adversely associated with birth head circumference (unstandardized β coefficient=-0.53,95％ CI:-1.05--0.01) in the first trimester and were associated with decreased birth weight (unstandardized β coefficient =-277.08,95％CI:-485.13--69.03) and length (unstandardized β coefficient=-1.39,95％CI:-2.26--0.53) in umbilical cord blood thallium.Conclusions Thallium exposure appeared a gender difference in newborn birth outcomes.In the first trimester,it was negatively associated with the birth head circumference,in the umbilical cord blood,and reduced birth weight and length in girls.

Study on the relationship of thallium exposure and outcomes of births / 中华流行病学杂志

Objective To investigate the relationship of thallium exposure and outcomes of births.Methods A total of 3 236 mothers who had visited in Ma'anshan Maternal and Child Health-Care Hospital between May 2013 and September 2014 were included in this study and their thallium concentrations measured from samples of maternal and umbilical cord blood by inductively coupled plasma mass spectrometry.The results were correlated and evaluated with birth outcomes of the infants,using the multiple linear regression method.Results The median (P25-P75) of thallium levels in first trimester,second trimester and umbilical cord blood were 61.7 (50.8-77.0),60.3 (50.8-75.2) and 38.5 (33.6-44.1) ng/L,respectively.After adjustment for potential confounders,the thallium levels showed an inversely significant association with birth head circumference (unstandardized β coefficient=-0.41,95％ CI:-0.76--0.06) in thc first trimester blood,and associated with reduced birth length (unstandardizedβ coefficient=-0.65,95％ CI:-1.25--0.05) in umbilical cord blood.However,there appeared no significantly associations with birth weight,length and head circumference (P＞0.05) in second trimester.On stratification by sex,in girls but not in boys,the thallium levels were adversely associated with birth head circumference (unstandardized β coefficient=-0.53,95％ CI:-1.05--0.01) in the first trimester and were associated with decreased birth weight (unstandardized β coefficient =-277.08,95％CI:-485.13--69.03) and length (unstandardized β coefficient=-1.39,95％CI:-2.26--0.53) in umbilical cord blood thallium.Conclusions Thallium exposure appeared a gender difference in newborn birth outcomes.In the first trimester,it was negatively associated with the birth head circumference,in the umbilical cord blood,and reduced birth weight and length in girls.

Influence of the Single Live Birth Outcome Following Transfer of Vitrified Blastocyst and Blastocyst Cultured from Thawing Cleavage Embryo / 中山大学学报(医学科学版)

[Objective]To compare the single live birth outcomes of blastocyst transfer between vitrified blastocyst and blastocyst cultured from thawing cleavage embryo,so as to choose the best scheme of blastocyst transfer.[Methods]Retrospective analysis of the single live birth clinical data of 1 037 vitrified blastocyst compared with 690 blastocyst cul-tured from thawing cleavage embryo undergoing frozen embryo transplantation(FET)from January 2014 to October 2016 was performed.Mail outcome were including gestational age,neonatal weight,proportion of male neonate,preterm birth rate,very preterm birth rate,low birthweight rate,very low birthweight rate,congenital anomalies rate.[Results]There were no differences between the two groups for gestational age,neonatal weight,proportion of Live birth,health baby and stillbirth(P>0.05). There were no differences in proportion of male neonate(AOR 1.07,95% CI 0.86~1.34),preterm birth rate(AOR 0.7,95% CI 0.49~1.01),very preterm birth rate(AOR 1.47,95% CI 0.55~3.96),low birthweight rate (AOR 1.38,95% CI 0.86~2.22),very low birthweight rate(AOR 0.76,95% CI 0.20~2.83),congenital anomalies rate (AOR 1.58,95% CI 0.66~3.76,P>0.05).[Conclusion]The blastocyst may be the preferable stage for vitrifying and transfer currently which can obtain good neonatal outcomes.

Association of Fatty Acid Ethyl Esters in Meconium of Neonates with Growth Deficits at Birth: a Prospective, Single-Centre Cohort Study

BACKGROUND: In this prospective cohort study, we investigated the association between fatty acid ethyl esters (FAEEs) in meconium as biomarkers of prenatal ethanol exposure and growth deficits, as birth outcomes, that constitute several of the key cardinal features of fetal alcohol syndrome. METHODS: A total of 157 meconium samples were collected from enrolled infants within 24 hours of birth, and nine FAEEs were quantified using liquid chromatography/tandem mass spectrometry. The relationships between cumulative concentrations of nine species of FAEEs in meconium and birth parameters of growth (age-sex-specific centiles of head circumference [HC], weight, and length) and respective and combined birth outcomes of growth deficits (HC ≤ 10th centile, weight ≤ 10th centile, and length ≤ 10th centile) were determined. RESULTS: Multivariate logistic regression analysis demonstrated that higher cumulative concentrations of meconium FAEEs correlated with elevated risks for HC and length, both, 10th percentile or less (adjusted odds ratio [aOR], 2.94; 95% confidence interval [CI], 1.12–7.74; P = 0.029) and HC and weight and length, all of them, 10th percentile or less (aOR, 3.27; 95% CI, 1.12–9.59; P = 0.031). CONCLUSION: The elevated cumulative FAEEs in meconium were associated with combined growth deficits at birth, specifically HC and length, both, 10th percentile or less, which might be correlated with detrimental alcohol effects on fetal brain and bone development, suggesting a plausible alcohol-specific pattern of intrauterine growth restriction.

Maternal and neonatal perinatal outcomes in pregnancies after in vitro fertilization and natural pregnancy: a systematic: a meta analysis / 重庆医学

Objective To systematically evaluate maternal perinatal complications and neonatal outcomes after in vitro fertili zation and embryo transplantation(IVF-ET).Methods The computer retrieval was performed on the databases of PubMed,Cochrane library,EMbase,CNKI,Wanfang and Chinese biomedical literature database.The articles on the comparison between IVF and natural pregnancy were included.The RevMan5.3 software was adopted to conduct the meta analysis.Results Twenty-three articles conforming to the requirements were included,including 1 312 651 cases,among them 113 044 cases were IVF and 1 199 607 cases were naturalpregnancy.IVF mother's age was larger than that of natural pregnancy,while the gestational weeks were smaller than those of natural pregnancy,the newborn birth weight was lighter than that of natural pregnancy(P＜0.05);the probability of pregnancy-induced hypertension (PIH),placenta previa,postpartum hemorrhage and gestational diabetes mellitus (GDM) occurrence in IVF mother were higher than that of natural pregnancy (P＜0.05);the rate of multiple and cesarean section in IVF mothers were higher than that of natural pregnancy (P＜0.05);the occurrence rates of small for gestational age(SGA),low birth weight infants,stillbirth and premature in IVF were higher than those of natural pregnancy (P＜0.05).Conclusion The maternal perinatal complications in IVF are higher than those of natural pregnancy,and the birth outcomes in IVF are worse than those of natural pregnancy.

Comparison of the Birth Statistics between Multi-cultural and Korean Families in Korea (2015)

Since 2002, the number of marriages, births, and family members among multi-cultural families (MCFs) has increased. Beginning in 2006, the government initiated a planned management for such families and has implemented the MCF policy basic plan since 2010. In 2015, with multiple socio-economic and medical support initiatives for MCF being available, we analyzed the statistics for several factors related to birth, to determine whether there are significant adverse birth outcomes in MCF. We analyzed the birth data of MCFs in 2015, from Statistics Korea. This study compared the birth data of MCF and Korean families (KF) by geography, neonatal birth weight (BW), gestational age (GA), birth order of the neonates, place of delivery, cohabitation period of parents before the first child, and parental education level. The distribution of BW and the prevalence of low BW (< 2,500 g) or very low BW (< 1,500 g) were similar between both groups. The incidence of preterm birth was lower in the MCF group (6.5% vs. 7.0%, P = 0.015) than in the KF group. In the MCF group, parental education level was lower, and incidence of out-of-hospital births was higher than that of the KF group. Adverse birth outcomes, such as preterm birth and low BW in MCF are similar or better than KF. This study could be a good basis to present the status of MCF birth and newborn care in 2015.

Interconception Health Services for Women at High Risk for Adverse Pregnancy Outcomes: A Descriptive Study.

Aims: To describe and present results of preconception care services aimed at underserved women who have experienced an adverse birth outcome. Study Design: Retrospective descriptive study. Place and Duration of Study: Sample: Maricopa Integrated Health System’s Internatal Clinic, a public safety-net hospital in Phoenix, Arizona USA, between March 2008 and October 2011. Methodology: 102 women who have experienced a prior preterm birth or stillbirth currently enrolled in an “Internatal Clinic” where interconception and prenatal care is provided. The interventions included education by clinicians and trained support staff, support groups, a walking program to address physical activity, contraception, folic acid intake, dental care, overweight/obesity, mental health and substance use issues prior to a future pregnancy. Chart reviews were performed and a preconception health survey addressing knowledge (pre/post) and patient satisfaction were analyzed using descriptive and univariate statistics. Results: Of current enrollees (N=102), 79% have been in the program for 12 to 18 months. 100% of those with mental health needs have had them addressed, 93% of those not desiring pregnancy are using contraception, 75% are consuming a folate supplement, 53% are engaging in regular exercise and 37% had oral health needs addressed despite no insurance coverage. Of the 102 patients, only 21% had a normal body mass index (18.5 to 24.9 kg/m2). Improvements in patient knowledge and attitudes were documented. Conclusion: Women in our program had improved preconception knowledge, attitudes and behaviors.

Relationship between folic acid supplements during peri-conceptional period and the adverse pregnancy outcomes: a cohort study / 中华流行病学杂志

Objective To examine the association between folic acid supplements during peri-conception and the related adverse birth outcome.Methods Pregnant women who received first prenatal care at 4 municipal-level medical institutions in Maanshan,from Oct.2008 to Oct.2010 were selected as the target population.All participants were asked to complete a self-administered questionnaire which including data on demographic characteristics,interval,complications and frequency of taking folic acid etc.,during pregnancy.The follow-up-records after delivery would include factors as:fetal weight,height,circumference of head,chest circumference of the neonates.Finally,4448 valid questionnaires were gathered,including 190 premature,147 small for gestational age and 104 low birth weight babies.Descriptive statistics and logistic regression models were used for data analysis.Results Data showed that the weight,height and head circumference of the fetels at birth among pregnant women who had taken supplementary standard folic acid during peri-conception period or only during the first trimester,were all better than those pregnant women who had not taken the standard folic acid supplements.After adjustment for potential confounders as gestational weeks,maternal age,mather' s education level,results from the logistic regression showed that intake of standard folic acid supplements appeared a protective factor for those babies who were smaller than the gestational age (RR=0.45,95％ CI:0.24-0.86),at premature delivery (RR=0.52,95％ CI:0.32-0.87) or with low birth weight (RR=0.39,95％CI:0.19-0.80).However,data from this study showed that provision of folic acid supplements to the pre-pregnant or at first trimester alone did not make obvious impact on those babies as prematured,small for gestational age and at low birth weight.Conclusion Standardized provision of folic acid supplements during peri-conceptional period could improve the outcomes of birth.

Efeitos do fumo materno durante a gestação e complicações perinatais / Effects of maternal smoking during pregnancy and perinatal complications

Objetivos: Avaliar o perfil de puérperas tabagistas no Hospital de Clínicas de Porto Alegre (HCPA), determinar a prevalência do tabagismo nestas pacientes e avaliar efeitos do fumo sobre a gestação e os recém-nascidos (RNs). Métodos: Estudo prospectivo, transversal, com dados coletados a partir de um questionário estruturado. Foram incluídas pacientes hígidas, com gestação a termo. Foram excluídas puérperas que tiveram gestações múltiplas, RNs com crescimento intrauterino restrito, anormalidades cromossômicas, malformações ou infecção intrauterina, e puérperas com dados incompletos no prontuário. As pacientes foram divididas em dois grupos: gestantes fumantes e não-fumantes. Foram avaliadas variáveis demográficas, clínicas e relacionadas à gestação, e variáveis relacionadas ao recém-nascido. Resultados: Foram incluídas no estudo 718 puérperas, sendo que 23% eram fumantes ativas durante a gestação. Não houve diferença estatística com relação à idade materna, número de cesarianas ou abortos e idade gestacional no momento do parto. Foram fatores de risco para o tabagismo na gravidez o maior número de gestações prévias, ser solteira ou separada, não branca, com menor escolaridade e não realizar pré-natal. O peso dos RNs foi estatisticamente menor no grupo das gestantes tabagistas, com uma variação média de 143g a menos nesse grupo. O número de RNs pequenos para idade gestacional foi significativamente maior no grupo de gestantes fumantes. A evolução clínica do RN, o peso da placenta e o índice de Apgar não foram diferentes entre os grupos. Conclusão: Este estudo foi relevante para o melhor conhecimento do perfil das puérperas fumantes do HCPA e aponta para a importância da realização de pré-natal e a busca de estratégias de tratamento para estas pacientes como forma de prevenção de complicações gestacionais e perinatais.

Aims: To evaluate the clinical profile of smoker post-pregnant women at Hospital de Clínicas de Porto Alegre (HCPA), to determine the prevalence of smoking in these patients and to evaluate the effects of smoking on pregnancy and on the newborns. Methods: This is a cross-sectional prospective study, with data collected through a structured questionnaire. Healthy patients with term pregnancies were included. Exclusion criteria were multiple pregnancies, newborns with intrauterine growth restriction, chromosomal abnormalities, malformations or intrauterine infection, and incomplete data on medical records. Patients were divided in two groups: smokers and non-smokers. Demographic and clinical variables were evaluated, as well as data related to the pregnancy and to the newborn. Results: Seven hundred and eighteen post-pregnant women were included in the study, of whom 23% were current smokers during pregnancy. There was no statistic difference regarding maternal age, number of cesarean sections or abortions, and gestational age at childbirth. Higher number of previous pregnancies, being single/separated, non-white, less education and no prenatal follow up visits were risk factors for smoking in pregnancy. The weight of the newborns was statistically lower in the smoking pregnant group, with a negative variation of 143 grams in average in this group. The number of newborns small for gestational age was significantly higher in the smoking pregnant group. Clinical evolution of the newborn, placenta weight and the Apgar score were not different between the groups. Conclusion: This study was relevant to improve the knowledge about the profile of post pregnant smokers at HCPA, underscores the importance of prenatal follow up visits and the need for treatment strategies to these patients as preventive measures to avoid perinatal and gestational complications.