Subjective and objective sleep among depressed and non-depressed postnatal women.

OBJECTIVE: Women sleep less in the postnatal period and it has been suggested that mothers diagnosed with depression alternatively could be suffering from the effects of chronic sleep deprivation. METHOD: From a population-based study, we recruited 42 women, of whom 21 scored >or=10 on the Edinburgh Postnatal Depression Scale. Sleep was registered by the Pittsburgh Sleep Quality Index (PSQI), sleep diaries and actigraphy 2 months after delivery. RESULTS: There were significant differences in subjective sleep measured retrospectively by the PSQI between depressed and non-depressed women. In contrast, there were no significant differences in sleep measured prospectively by sleep diaries and actigraphy. Both depressed and non-depressed women had impaired sleep efficiency (82%) and were awake for about 1.5 h during the night. Primipara had worse sleep, measured by actigraphy, compared with multipara. CONCLUSION: Measured objectively and prospectively, women with depression did not have worse sleep than non-depressed women.

Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections.

OBJECTIVE: We studied the association between anemia in pregnancy and characteristics related to nutrition and infections. DESIGN: Cross-sectional study. SETTING: Four antenatal clinics in rural northern Tanzania. SUBJECTS/METHODS: A total of 2547 women were screened for hemoglobin (Hb) and malaria plasmodia in capillary blood and for infections in urine. According to their Hb, they were assigned to one of five groups and selected accordingly, Hb<70 g/l (n=10), Hb=70-89 g/l (n=61), Hb=90-109 g/l (n=86), Hb=110-149 g/l (n=105) and Hb> or =150 g/l (n=50). The 312 selected subjects had venous blood drawn, were interviewed, and their arm circumference was measured. The sera were analyzed for ferritin, iron, total iron binding capacity (TIBC), cobalamin, folate, vitamin A, C-reactive protein (CRP), and lactate dehydrogenase (LD). Transferrin saturation (TFsat) was calculated. Urine was examined by dipsticks for nitrite. MAIN OUTCOME MEASURES: Unadjusted and adjusted odds ratio (OR and AOR) of anemia with Hb<90 g/l. RESULTS: Anemia (Hb<90 g/l) was associated with iron deficiency (low s-ferritin; AOR 3.4). The association with vitamin deficiencies were significant in unadjusted analysis (low s-folate; OR 3.1, low s-vitamin A; OR 2.6). Anemia was also associated with markers of infections (elevated s-CRP; AOR 3.5, urine nitrite positive; AOR 2.4) and hemolysis (elevated s-LD; AOR 10.1). A malaria positive blood slide was associated with anemia in unadjusted analysis (OR 2.7). An arm circumference less than 25 cm was associated with anemia (AOR 4.0). The associations with less severe anemia (Hb 90-109 g/l) were similar, but weaker. CONCLUSIONS: Anemia in pregnancy was associated with markers of infections and nutritional deficiencies. This should be taken into account in the management of anemia at antenatal clinics. SPONSORSHIP: The study was supported by the Norwegian Research Council (NFR) and the Centre for International Health, University of Bergen.

Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?

OBJECTIVE: The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women. DESIGN: Cross-sectional study. SETTING: Patan Hospital, Kathmandu, Nepal. SUBJECTS: A sub-sample (n=382) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. The selection of the sub-sample was based on maternal haematocrit values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n=54) were excluded. The remaining women (n=328) were included in the statistical analysis. RESULTS: Overall mean values (+/-s.d.) of s-tHcy and s-MMA were 9.5 (+/-4.2) micromol/l and 0.39 (+/-0.32) micromol/l, respectively. Elevated s-tHcy (>7.5 micromol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 micromol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (< or =4.5 nmol/l). s-tHcy was significantly correlated with s-MMA (r=0.28, P<0.001), s-cobalamin (r=-0.30, P<0.001) and s-folate (r=-0.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r=-0.40, P<0.001), but not with s-folate. CONCLUSIONS: Functional cobalamin deficiency was very common in the study population, while functional folate deficiency was rather uncommon. We suggest considering cobalamin supplementation to pregnant Nepali women. SPONSORSHIP: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.

Maternal hematological status and risk of low birth weight and preterm delivery in Nepal.

BACKGROUND: Our aim was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant Nepali women. METHODS: In a case-control study, 1400 pregnant women attending Patan Hospital, Kathmandu, Nepal for antenatal care and delivery in the period 1994 to 1996 were included. Women with twin pregnancies (n=15) and those delivering infants with congenital malformations (n=13) were excluded from the study. Maternal characteristics including hematocrit values were recorded at the first antenatal visit. Main outcome measures included birth weight, gestation at delivery, Apgar score, mode of delivery, and perinatal death. Linear and logistic regression models were used to analyze data. RESULTS: Severe anemia (hematocrit < or =24%) was associated with a significantly increased risk of low birth weight (<2500 g) and preterm delivery (<37 weeks gestation). High hematocrit values (> or =40%) did not increase the risk of low birth weight or preterm delivery. The risk of low Apgar score or operative deliveries was significantly increased in women with severe anemia in the first trimester. Teenagers, women with short height or low body mass index, and those belonging to the ethnic group Brahmins, had significantly higher risks of delivering low birth weight infants. CONCLUSIONS: Severe maternal anemia, particularly in the first trimester, was significantly associated with adverse pregnancy outcome. Low maternal age, height or body mass index also increased the risk of low birth weight. Improvements in the nutritional status of young Nepali women could contribute to improved health among their infants.

The prevalence of anemia in pregnant Nepali women--a study in Kathmandu.

BACKGROUND: Anemia in pregnancy is associated with maternal and perinatal morbidity and mortality. The World Health Organization has suggested that where up-to-date information is not available, prevalence studies should be undertaken. METHODS: The distribution of hematocrit in 2280 pregnant women attending Patan Hospital, Kathmandu, for their first antenatal visit in a twelve month period, 1994-95, was studied. Anemia was defined as a hematocrit value < or =34% in the first and third trimesters, or < or =33% in the second trimester. Severe anemia was defined as a hematocrit value < or =24%. The prevalence of anemia and severe anemia, and associations with socio-demographic (age, ethnic group, living area, maternal and paternal education and occupation) and biological (height, body mass index, parity, gestation) variables were investigated. RESULTS: The hematocrit values ranged from 11-49% with a mean value of 32.6% (s.d. 3.9). The prevalences of anemia and severe anemia were 62.2% and 3.6%, respectively. High prevalence of anemia was observed among teenagers, farmers, women of short height, the ethnic groups Lama/Sherpa/Tamang, and women married to industrial workers or illiterate men. Also, the risk of anemia increased with gestation. Work within the service professions, higher education and high body mass index, were associated with a lower risk of anemia. CONCLUSIONS: A high prevalence of anemia among pregnant women in Kathmandu was observed. The hematocrit values were related to socio-demographic and biological factors. In order to plan focused and effective intervention, studies on the etiology of anemia among pregnant women in rural and urban areas of Nepal need to be carried out.

Seasonal variation in risk of anemia among pregnant Nepali women.

OBJECTIVE: We aimed to investigate whether there is any seasonal variation in risk of anemia among pregnant Nepali women. METHODS: We studied the hematocrit values in pregnant women (n=5495) attending Patan Hospital, Kathmandu for the first antenatal visit in the 2-year period from January 1994 until December 1995. In a sub-sample of subjects (n=2706), additional information was obtained through interviews and clinical examinations. Logistic regression models were used to analyze data. RESULTS: Mean hematocrit values recorded in the monsoon period were significantly lower than hematocrit values recorded in the winter. The prevalence of moderate (hematocrit 25-33%) and severe (hematocrit<25%) anemia was highest in September. CONCLUSIONS: We found a clear seasonal variation in risk of anemia, which was associated with rainfall and temperature. The monsoon seems to be a period when interventions may give the most beneficial effects.

Anaemia in pregnancy: possible causes and risk factors in Nepali women.

OBJECTIVE: The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women. DESIGN: Case-control study. SETTING: Patan Hospital, Kathmandu, Nepal. SUBJECTS: A sub-sample (n=479) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. Women who had already received any micronutrient supplementation (n=82), and those whose serum samples showed macroscopic haemolysis (n=7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n=82), and two case-groups: moderately anaemic, Hct 25-33% (n=254), and severely anaemic, Hct<25% (n=54). RESULTS: We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively. CONCLUSIONS: In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care. SPONSORSHIP: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education. European Journal of Clinical Nutrition (2000) 54, 3-8