Toxic metals in maternal blood, cord blood and meconium of newborn infants in Pakistan.

Toxic metals and deficiency/excess of trace elements can have adverse effects on health. The aim of this study was to quantify toxic metals lead, cadmium and trace elements zinc, copper, aluminium (Al) and Iron (Fe) levels in pregnant women, cord blood and meconium of new-born infants from industrial zones of Karachi, Pakistan. Analytical research was performed from 2011-2012 in low socio-economic pregnant mothers and newborn infants from 20 towns near Sindh Industrial Trading Estates, Federal B industrial area and Korangi industrial areas, Karachi, where environmental pollution was anticipated. Blood samples of pregnant women (n = 416), cord blood (n = 309) and meconium (n = 309) were analyzed quantitatively for metals and trace elements. Results indicated that mothers residing in steel towns were found to have the highest levels of lead. Meconium contained high levels of toxic heavy metals and trace elements compared to cord blood and maternal blood. Maternal blood toxic metals were present in high quantities. Therefore, safety measures should be taken when industrial waste is disposed of in order to prevent population contamination.

Preterm birth and its associated risk factors. A study at tertiary care hospitals of Karachi, Pakistan.

OBJECTIVE: To study the factors associated with the risk of preterm birth among local population of Karachi, Pakistan. METHODS: This case control study was carried out on all those patients who were admitted in the post-partum wards of Civil Hospital and Abbasi Shaheed Hospital Karachi, during the period of January to May 2011. A total of 600 patients were part of this study. All those women who had preterm delivery (delivery at <37 weeks of gestation) were grouped together as case-group (n=300), while women who had term delivery (delivery ?37 and <42 weeks of gestation) were grouped as control-group (n=300). Data was collected by the help of a questionnaire which included questions related to the previous and current gestational history of the mothers, their nutritional status, drug addictions, urogenital, dental or systemic diseases they suffered, along with any physical or emotional stress they experienced during pregnancy. Last menstrual period and ultrasound reports were brought into use to calculate the precise gestational age of the baby. Data collected from the two groups were then compared to find out the possible risk factors of preterm delivery. RESULTS: A total of 600 subjects were divided into two equal groups of cases (n=300) and controls (n=300). There were 30 (10%) patients in the case-group and 33 (11%) patients in the control-group who were above 35 years of age (p<0.05). At the time of delivery, 111 (37%) cases and 51 (17%) controls weighed <50 kg (p <0.01). There were 264 (88%) cases and 117 (39%) controls with a haemoglobin level <10 gm/dL (p <0.01). In the case-group, 15 (5%) patients had a history of previous multiple preterm deliveries, 24 (8%) had one previous preterm delivery, and 261 (87%) had no previous preterm delivery. In the control-group, no patient had a history of multiple preterm deliveries, 15 (5%) had one previous preterm delivery, and 285 (95%) had no previous preterm deliveries (p<0.05). Common symptoms experienced in the gestational period in the case-group were dizziness/weakness (228; 76%), pain/malaise (213; 71%) and emotional stress such as anger (207; 69%). In the control-group the distribution was as follows: dizziness/weakness (168; 56%), emotional stress such as anger (165; 55%) and pain/malaise (141; 47%) (p<0.01). In the case-group, 69 (23%) women consumed fish, milk and pulses on a weekly basis, 177 (59%) on a monthly basis, and 54 (18%) did not take them at all. In the control-group, 174 (58%) patients consumed fish, milk and pulses on weekly basis, 90 (30%) on a monthly basis, and 36 (12%) did not take them at all (p<0.01). About 66 (22%) patients from the case-group and 21 (7%) in the control-group had evidence of periodontal disease on physical examination (p<0.05). CONCLUSION: Low maternal weight, multiple previous preterm deliveries, periodontal diseases, maternal anaemia, physical and emotional stress are among the factors associated with the risk of preterm birth among the local population delivering in tertiary care, governmental hospitals of Karachi, Pakistan.

Vertical transmission of hepatitis C virus in low to middle socio-economic pregnant population of Karachi.

PURPOSE: To determine the rate of vertical transmission (transmission from mother to child) of hepatitis C virus in low to middle socio-economic pregnant women. METHODS: This study was conducted at Sarwar Zuberi Liver Centre (SZLC) in collaboration with the department of Gynaecology and Obstetrics, Civil Hospital Karachi (CHK) and Abbasi Shaheed Hospital (ASH) for a period of 4 years from September 2005 to December 2009. Total 18,000 women seeking antenatal care were screened for hepatitis C antibodies (Anti-HCV) using 4th generation ELISA technique. Positive 1,043 women were further offered HCV ribonucleic acid (RNA) by polymerase chain reaction (PCR). Six hundred and forty women agreed to have PCR done, and 510 PCR positive women were finally included in the study, followed till delivery and treated if required. Newborns of 510 PCR positive mothers were advised HCV-RNA by PCR from 3 to 12 months of age and Anti-HCV at 18 up to 24 months and followed up to 3 years. RESULTS: 1,043/18,000 (5.79%) mothers were Anti-HCV positive, of which PCR results of 640 mothers are available where 510/640 (79.7%) were PCR positive, 357/510 (70%) delivered by spontaneous vaginal delivery (SVD), 33 (6.4%) by forceps delivery, 70 (13.7%) had elective, and 50 (9.8%) had emergency caesarian section. Premature rupture of membranes (PROM) was present in 81 mothers. Data of 510 babies from 3 months to 3 years of age was available of which only 215 had their laboratory tests done (HCV-RNA-PCR in 86 and Anti-HCV in 129). Mean birth weight (kg), height (cm) and OFC (cm) were 2.74 ± 0.43, 52.4 ± 7.5, and 35 ± 4. Apgar score median at 1 and 5 min was 7 (range 2-10), 8 (range 4-10), respectively. Low birth weight was present in 49 (9.6%), 37 (7.2%) had history of Neonatal Intensive Care Unit (NICU) admission. PCR of none of the 86 babies done at 3-12 months was positive. Five babies out of 129 were Anti-HCV positive at 18 months of age. Of this, 3/5 was HCV-RNA-PCR positive. Rate of vertical transmission of HCV was 1.39. CONCLUSION: In spite of the high hepatitis C positivity in pregnant population, the rate of vertical transmission to the neonate is low.