Obstetric anal sphincter injury risk reduction: a retrospective observational analysis.

OBJECTIVE: To identify the risks of sustaining obstetric anal sphincter injury (OASI) during childbirth. METHODS: Data were analysed from 12,612 vaginal deliveries recorded at Northwick Park District General Hospital, London, from 1 January 2006 to 30 November 2009. RESULTS: A total of 85.6% were spontaneous deliveries and 14.2% were instrument deliveries. The majority (64.5%) sustained some form of perineal damage, 3.7% being OASI. Logistic regression analyses revealed the risk factors for OASI to be Asian ethnicity [odds ratio (OR) 4.798, 95% confidence interval (CI) 2.998-7.679], a maternal age of >40 years (OR 2.722, 95% CI 1.315-5.636), higher foetal birth weight (>4500 g; OR 6.228, 95% CI 2.695-14.392), lower parity (para 0; OR 16.803, 95% CI 7.697-36.685), and instrumental delivery. Forceps delivery posed the greatest risk (OR 8.4, 95% CI 5.822-12.151). Not having an episiotomy increased the risk of OASI by five times compared with having one. CONCLUSIONS: Risk factors for OASI include maternal age >40 years, higher foetal birth weight, lower parity, instrumental delivery, and Asian ethnicity. Mediolateral episiotomy appears to reduce the risk of OASI. Specific variables have been identified for incorporation into a risk-reduction strategy that could be introduced antenatally to evaluate and assess OASI risk.

Vitamin D deficiency in pregnancy - still a public health issue.

The objectives of this study were to quantify the prevalence of vitamin D insufficiency and deficiency in pregnancy, explore associated risk factors and discuss the public health implications. The study used retrospective analysis of randomly selected data. This is the first report on serum vitamin D levels in an unselected multi-ethnic population of pregnant women collected between April 2008 and March 2009. Women with sufficient stored serum were randomly selected from among all women who delivered between April 2008 and March 2009. Serum vitamin D levels were determined using liquid chromatography coupled to tandem mass spectrometry. Vitamin D levels were analysed with respect to ethnicity (marking skin tone), calendar quartile, body mass index (BMI), trimester and parity. Deficiency was defined as <25 nmol L(-1) , insufficiency 25-75 nmol L(-1) and adequacy >75 nmol L(-1) . Three hundred and forty-six women were included and represented the total population regarding skin tone, quartile, BMI, gestation and parity. Overall, 18% [95% confidence interval (CI): 15-23%] of sample women had adequate vitamin D levels; 36% were deficient, 45% insufficient. Among women with dark skin, only 8% (95% CI: 5-12%) had adequate levels compared with 43% (95% CI: 33-53%) of those with light skin. Obese women were found have significantly lower vitamin D levels than non-obese women. Vitamin D deficiency and insufficiency are prevalent year-round among pregnant women in North West London, especially those with darker skin. Existing supplementation guidelines should be supported; however, other measures are required to improve status among all women.

Obesity and Vitamin D Deficiency - Current Concepts on their Impact on Pregnancy.

Both obesity and vitamin D deficiency are linked to morbidity and ultimately mortality. Vitamin D sufficiency is believed to confer many health benefits; however, with the exception of the classic functions related to bone health these are not yet well understood, especially in relationship to pregnancy and infant health outcomes.1 Conversely, insufficiency is associated with adverse health outcomes, which are consequently related to public health concerns that arise from these and these need addressing.2,3 While the links between health and vitamin D are being considered and researched, there are an increasing number of reports that demonstrate vitamin D deficiency is prevalent particularly among people who are darker skinned, those who live at latitudes above 52°, and are therefore exposed to reduced sunlight especially in the autumn and winter months, those who through lifestyle choices cover their bodies, preventing sunlight exposure, and in obese people.3-6 Obesity is also of growing concern. Health journalists and academics sometimes dramatically refer to 'obesity epidemics,' which is not surprising as over one-third of Americans are obese.7-9 This problem, if not addressed, will lead to adverse health outcomes for individuals as well as being a long-term burden both to families and society.10-11 It is interesting to note that both vitamin D deficiency and obesity have shared risks for mortality and morbidity including cardiovascular disease, diabetes, respiratory problems, cancer and musculoskeletal disease. This paper considers current concepts and the links between obesity and vitamin D deficiency in pregnancy seeking to determine whether being vitamin D deficient and obese is simply double trouble, where both are present, or whether there are there other factors that need further exploration, reviewing the associated implications for practice.12-15.