1.  Title: Kangaroo mother care for low birth weight babies: a prospective observational study. Source: Journal of Nepal Paediatric Society. 2009 Jan-Jun;29(1):6-9. Abstract: Introduction: Kangaroo Mother Care is the low cost, humane technique for caring low birth weight babies by direct skin to contact with the mother. Objective: The Prospective observational study was done to see the effect of KMC especially on weight gain on low birth weight babies weighing 2000 grams or less at Special Care Baby Unit of Paropakar Maternity and Women's hospital, Kathmandu. Method: The study was conducted in Special Care Baby Unit (SCBU) of Paropakar Maternity and Women's Hospital over 7 months period May 2007 to Nov. 2008 (from Baishakh 2064 to Kartik 2065). The method of care consisted of skin to skin contact between the mother and the infant. Result: It was observed that babies had good weight gain of average 30gms/day and had short duration of hospital stay of average 9 days. Babies had less morbidities like hypothermia, apnea, skin infections and oral thrush.100% babies had exclusive breast feeding and KMC was acceptable to mothers. Conclusion: Kangaroo Mother Care shows early and good weight gain in low birth weight babies. It is simple, low cost technique and well acceptable by mother and family and can be continued at home. Language: English Keywords: NEPAL | RESEARCH REPORT | PROSPECTIVE STUDIES | INFANT | LOW BIRTH WEIGHT | TREATMENT | INFANT HEALTH | GESTATIONAL AGE | BREASTFEEDING, EXCLUSIVE | COST EFFECTIVENESS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Birth Weight | Body Weight | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Child Health | Fetus | Pregnancy | Reproduction | Breastfeeding | Infant Nutrition | Nutrition | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 341512 |
2.  Peer Reviewed Title: Perinatal outcomes in a South Asian setting with high rates of low birth weight. Author: George K; Prasad J; Singh D; Minz S; Albert DS; Muliyil J; Joseph KS; Jayaraman J; Kramer MS Source: BMC Pregnancy and Childbirth. 2009;9:5. Abstract: BACKGROUND: It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference. METHODS: Population-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA) live births were identified using both a recent Canadian and an older Indian fetal growth standard. RESULTS: The low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and < 1% in Nova Scotia when the Indian standard was used. In Kaniyambadi, low birth weight, preterm birth and perinatal mortality rates did not decrease between 1990 and 2005. SGA rates in Kaniyambadi declined significantly when SGA was based on the Indian standard but not when it was based on the Canadian standard. Maternal mortality rates fell by 85% (95% confidence interval 57% to 95%) in Kaniyambadi between 1986-90 and 2001-05. Perinatal mortality rates were 11.7 and 2.6 per 1,000 total births and cesarean delivery rates were 6.0% and 20.9% among live births >or= 2,500 g in Kaniyambadi and Nova Scotia, respectively. CONCLUSION: High rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories. Language: English Keywords: INDIA | CANADA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CROSS-CULTURAL COMPARISONS | LONGITUDINAL STUDIES | INFANT | INFANT, PREMATURE | PREVALENCE | BIRTH WEIGHT | LOW BIRTH WEIGHT | GESTATIONAL AGE | PERINATAL MORTALITY | GROWTH | MATERNAL MORTALITY | Asia, Southern | Asia | Developing Countries | Developed Countries | North America, Northern | Americas | Research Methodology | Comparative Studies | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Body Weight | Physiology | Biology | Fetus | Pregnancy | Reproduction | Mortality | Population Dynamics | Child Development Document Number: 331227 |
| 3. Peer Reviewed Title: Geophagy (Soil-eating) in relation to Anemia and Helminth infection among HIV-infected pregnant women in Tanzania. Author: Kawai K; Saathoff E; Antelman G; Msamanga G; Fawzi WW Source: American Journal of Tropical Medicine and Hygiene. 2009 Jan;80(1):36-43. Abstract: Geophagy, the regular and deliberate consumption of soil, is prevalent among pregnant women in sub-Saharan Africa. We examined the associations of geophagy with anemia and helminth infection among 971 human immunodeficiency virus (HIV)-positive pregnant women in Tanzania. About 29% of pregnant women regularly consumed soil. Occupation, marital status, and gestational age were associated with geophagy. Ascaris lumbricoides infection was associated with the prevalence of geophagy (adjusted-prevalence ratio 1.81; 95% confidence interval [CI] = 1.37-2.40); however, hookworm, Trichuris trichiura, and Strongyloides stercoralis showed no association. Anemia and red blood cell characteristics suggestive of iron deficiency were strongly correlated with geophagy at baseline. In longitudinal analyses, we found evidence suggesting that soil consumption may be associated with an increased risk of anemia (adjusted-relative risk 1.16; 95% CI = 0.98-1.36) and a lower hemoglobin concentration (adjusted-mean difference -3.8 g/L; 95% CI [-7.3, -0.4]). Pregnant women should be informed about the potential risks associated with soil consumption. Language: English Keywords: TANZANIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREVALENCE | PARASITIC DISEASES | ANEMIA | COMPLICATIONS | OCCUPATIONS | MARITAL STATUS | GESTATIONAL AGE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Measurement | Human Resources | Nuptiality | Fetus | Pregnancy | Reproduction Document Number: 330314 |
| 4. Peer Reviewed Title: Non-physician clinicians can safely provide first trimester medical abortion. Author: Yarnall J; Swica Y; Winikoff B Source: Reproductive Health Matters. 2009 May;17(33):61-69. Abstract: Mid-level clinicians are integral to provision of pregnancy-related care in many settings. Yet midwives and other non-physician clinicians are excluded from training and from providing medical abortion. A substantial body of evidence exists demonstrating that mid-level providers, including nurses and midwives specialized in pregnancy-related care for women, are either already competently involved in providing medical abortions or have the requisite skills to expand their scope of practice to include medical abortion with a short course of additional training. While additional evidence may be needed to show that second trimester medical abortion can be safely and effectively provided by trained mid-level providers, we argue that for first trimester medical abortion the evidence is sufficient for governments to implement, monitor and evaluate programmes that allow mid-level clinicians to offer first trimester medical abortion independently. Because mid-level clinicians often work in rural or remote areas where physicians are scarce or where there are few surgical facilities or equipment, the expansion of the medical abortion provider pool has the potential to greatly improve the reproductive health of women worldwide. Spanish Abstract: En muchos lugares, el personal médico de nivel intermedio es fundamental en la atención relacionada con el embarazo. No obstante, las parteras profesionales y otros profesionales de la salud no médicos son excluidos de recibir capacitación y proporcionar servicios de aborto con medicamentos. Existe un considerable conjunto de pruebas que demuestran que los prestadores de servicios de nivel intermedio, como las enfermeras y parteras profesionales especializadas en la atención del embarazo, ya participan competentemente en efectuar procedimientos de aborto con medicamentos o cuentan con las habilidades necesarias para realizar abortos con medicamentos si atienden un curso corto de capacitación adicional. Aunque se necesitan más pruebas para demostrar que los profesionales de nivel intermedio capacitados pueden efectuar procedimientos de aborto con medicamentos en el segundo trimestre de manera segura y eficaz, argüimos que para el primer trimestre existe suficiente evidencia para que los gobiernos establezcan, monitoreen y evalúen programas que permitan que los profesionales de la salud de nivel intermedio ofrezcan servicios de aborto con medicamentos de primer trimestre independientemente. Dado que estos profesionales suelen trabajar en zonas rurales o remotas donde los médicos son escasos o donde existen pocos centros o equipos quirúrgicos, al ampliarse el grupo de prestadores de servicios de aborto con medicamentos se podría mejorar notablemente la salud reproductiva de las mujeres del mundo. French Abstract: Les cliniciens de niveau intermédiaire font souvent partie intégrante des soins liés à la grossesse. Pourtant, les sages-femmes et autres cliniciens non médecins sont exclus de la formation et de la pratique de l'avortement médicamenteux. Or, une somme considérable de données montre que les prestataires de niveau intermédiaire, notamment les infirmières et les sages-femmes spécialisées dans les soins liés à la grossesse, sont déjà engagés avec compétence dans les avortements médicamenteux ou possèdent les aptitudes requises pour élargir leur pratique et y inclure l'avortement médicamenteux après une brève formation complémentaire. Si des recherches supplémentaires seront peut-être nécessaires pour montrer que les prestataires de niveau intermédiaire peuvent pratiquer efficacement et en toute sécurité l'avortement médicamenteux du deuxième trimestre, nous estimons qu'il existe suffisamment de preuves pour que les gouvernements appliquent, surveillent et évaluent des programmes qui autoriseront les cliniciens de niveau intermédiaire à proposer de manière indépendante des avortements médicamenteux du premier trimestre. Comme ces cliniciens travaillent souvent dans des zones rurales ou éloignées, où les médecins sont rares ou qui disposent de peu de centres ou d'équipements chirurgicaux, l'expansion du corps de prestataires de l'avortement médicamenteux peut améliorer sensiblement la santé génésique des femmes dans le monde. Language: English Keywords: GLOBAL | CRITIQUE | MIDWIVES AND MIDWIFERY | NURSE-MIDWIVES | PARAMEDICAL PERSONNEL | ABORTION | PREGNANCY, FIRST TRIMESTER | SAFETY | TRAINING PROGRAMS | GESTATIONAL AGE | HEALTH POLICY | LEGISLATION | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Public Health | Education | Fetus | Policy | Political Factors | Sociocultural Factors Document Number: 342015 Notification |
| 5. Peer Reviewed Title: Predictors of serum ferritin and haemoglobin during pregnancy, in a malaria-endemic area of western Kenya. Author: Alusala DN; Estambale BB; Magnussen P; Friis H; Luoba AI Source: Annals of Tropical Medicine and Parasitology. 2008 Jun;102(4):297-308. Abstract: Between 2000 and 2004, a cross-sectional survey was conducted, as part of a prospective cohort study, among the women attending antenatal-care clinics in Bondo district, a malaria-endemic area of western Kenya. The aim was to assess the prevalence of iron deficiency and determine the predictors of haemoglobin and serum ferritin concentrations in the women who had a gestational age between 14 and 24 weeks. A standardized questionnaire was used to collect and store the relevant bio-data for the study. Haemoglobin and ferritin concentrations were evaluated, sickle-cell status was determined, and malarial parasitaemias were detected and evaluated, using blood samples collected at enrolment. Multiple regression analysis was then used to test for significant predictors of the haemoglobin and serum ferritin concentrations. Although 842 women were enrolled in the prospective cohort study, haemoglobin concentrations were evaluated for only 828 of them, serum ferritin levels for 621, and levels of parasitaemia for 812. The mean haemoglobin concentration recorded was 10.9 g/dl. Although 37.9% of the subjects had mild-moderate anaemia (7.0-10.5 g haemoglobin/dl), only 0.5% were severely anaemic (less than 7.0 g haemoglobin/dl). The geometric mean serum ferritin concentration recorded was 18.9 mg/litre, and 32.3% of the subjects evaluated had low serum concentrations of ferritin (less than 12 microg/litre). Among the parasitaemic primigravidae (but not the parasitaemic multigravidae), those found positive for sickle-cell trait had significantly lower haemoglobin concentrations than those found negative in a sickling test (P = 0.01). Among the pregnant women of Bondo district, gravidity, malarial infection and sickle cell appear to be key predictors of haemoglobin concentration. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SURVEYS | PREGNANT WOMEN | GESTATIONAL AGE | IRON | DEFICIENCY DISEASES | PREVALENCE | HEMOGLOBIN LEVEL | MALARIA | TRANSMISSION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Sampling Studies | Studies | Population Characteristics | Demographic Factors | Population | Fetus | Pregnancy | Reproduction | Metals | Vitamins and Minerals | Physiology | Biology | Nutrition Disorders | Diseases | Measurement | Hemic System | Parasitic Diseases | Infections Document Number: 327216 |
| 6. Peer Reviewed Title: Timing of intermittent preventive treatment for malaria during pregnancy and the implications of current policy on early uptake in north-east Tanzania. Author: Anders K; Marchant T; Chambo P; Mapunda P; Reyburn H Source: Malaria Journal. 2008 May 9;7:79. Abstract: Intermittent preventive treatment (IPTp) is efficacious in reducing the adverse outcomes associated with pregnancy-associated malaria, however uptake of the recommended two doses is low in Tanzania, and little is known of the timepoint during pregnancy at which it is delivered. This study investigated the timing of delivery of IPTp to pregnant women attending antenatal clinics (ANC), and the potential determinants of timely uptake. Structured interviews were conducted with staff and pregnant women at antenatal clinics in northeast Tanzania, and antenatal consultations were observed. Facility-based and individual factors were analysed for any correlation with timing of IPTp uptake. Almost half the women interviewed first attended ANC during or before the fourth month of gestation, however 86% of these early attendees did not receive IPTp on their first visit. The timing of IPTp delivery complied closely with the national guidelines which stipulate giving the first dose at 20-24 weeks gestation. Uptake of at least one dose of IPTp among women who had reached this gestation age was 67%, although this varied considerably between clinics. At one facility, IPTp was not delivered because SP was out of stock. Early uptake of IPTp was found to be hampered by factors external to health worker performance or women's individual preferences. These include insufficient drug stocks and an apparent lack of information to health workers on the reasoning for continued use of SP for IPTp when it has been replaced as a first-line treatment. In addition, an unexpectedly high proportion of women attend antenatal clinics before 20 weeks of pregnancy. While current policy denies the use of IPTp at this time, there is emerging, but incomplete, evidence that malaria in early pregnancy may contribute considerably to the burden of pregnancy-related malaria. Current policy may thus result in a missed opportunity for maximising the benefit of this intervention, and efforts to encourage earlier attendance at ANC alone are unlikely to improve uptake of IPTp. More evidence is needed to weigh the benefits of early IPTp use against theoretical risks of antifolate drugs in early pregnancy. (author's) Language: English Keywords: TANZANIA | RESEARCH REPORT | INTERVIEWS | PREGNANT WOMEN | ANTENATAL CARE | GESTATIONAL AGE | CLINIC VISITS | MALARIA PREVENTION | MALARIA | TREATMENT | QUALITY OF HEALTH CARE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health | Fetus | Pregnancy | Reproduction | Service Statistics | Program Activities | Programs | Organization and Administration | Parasitic Diseases | Diseases | Medical Procedures | Medicine | Health Services Evaluation | Program Evaluation Document Number: 326735 |
| 7. Title: The association between domestic violence during pregnancy and low birth weight or prematurity. Author: Audi CA; Correa AM; Latorre MR; Santiago SM Source: Jornal de Pediatria. 2008 Jan-Feb;84(1):60-67. Abstract: The objective was to investigate whether domestic violence during pregnancy is associated with unfavorable infant health outcomes, measured by low birth weight or prematurity. This was a prospective cohort study enrolling pregnant women whose prenatal care was provided by 10 basic health units in the city of Campinas, SP, Brazil, between 2004 and 2006. A structured questionnaire was employed that had previously been validated for use in Brazil. Each mother attended a minimum of two and a maximum of three interviews during the prenatal and postnatal periods. Data were analyzed using descriptive statistics. Student's t test was used to compare means for birth weight and gestational age between mothers who had suffered domestic violence during the current pregnancy and those who had not. Logistic regression analysis was employed to identify factors associated with low birth weight or prematurity. During the prenatal and postnatal periods, 89.1% (n = 1,229) of the pregnant women were followed up, 10.9% being lost to follow-up, basically due to changes of address. Mean birth weight was 3,233 g; mean gestational age was 38.56 weeks. A total of 13.8% of the infants had low birth weight or were premature. Conditions associated with risk of low birth weight or prematurity were: mothers who had previously given birth prematurely (p less than 0.005), who smoked (p less than 0.001), who delivered by caesarian (p less than 0.001) and whose partners had a low educational level (p less than 0.008). In this study, no statistically significant association was observed between domestic violence perpetrated by partners and low birth weight or prematurity. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | KAP SURVEYS | PROSPECTIVE STUDIES | COHORT ANALYSIS | FOLLOW-UP STUDIES | PREGNANT WOMEN | INFANT, PREMATURE | INFANT | WOMEN IN DEVELOPMENT | LOW BIRTH WEIGHT | DOMESTIC VIOLENCE | GESTATIONAL AGE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Economic Development | Economic Factors | Birth Weight | Body Weight | Physiology | Biology | Crime | Social Problems | Sociocultural Factors | Fetus | Pregnancy | Reproduction Document Number: 325265 |
| 8. Peer Reviewed Title: HIV may not increase risk of stillbirth among women in sub-Saharan Africa. Author: Ball H Source: International Family Planning Perspectives. 2008 Mar;34(1):53. Abstract: In Sub-Saharan Africa, a pregnant woman's HIV status is not directly linked to the likelihood that her fetus will be stillborn, data from a randomized trial suggest. Instead, inflammation of the amniotic sac during pregnancy, hemorrhage during labor and delivery outside a hospital or clinic are the factors most strongly associated with stillbirth. The study was a secondary analysis of data from a randomized, placebo-controlled trial that examined whether antibiotics would help prevent mother-to-child HIV transmission associated with chorioamnionitis, a bacterial infection of the amniotic sac. Women were eligible for the trial, which was conducted in 2001-2003 at four clinics in Malawi, Tanzania and Zambia, if they were between 20 and 24 weeks' gestation, had a documented HIV infection, had not recently received antibiotics and had no serious conditions that might complicate pregnancy outcome. Although the goal of the trial was to prevent perinatal HIV transmission, a small proportion of HIV-negative women were recruited at all but one site to help reduce the stigma associated with the trial. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | SUMMARY REPORT | MULTIVARIATE ANALYSIS | PREGNANT WOMEN | HIV INFECTIONS | CAUSES OF DEATH | FETAL DEATH | GESTATIONAL AGE | INTERVENTIONS | Developing Countries | Africa | Data Analysis | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Mortality | Population Dynamics | Fetus | Pregnancy | Reproduction | Programs | Organization and Administration Document Number: 326252 |
| 9. Title: Predictors of mortality in very low birth weight neonates in India. Author: Basu S; Rathore P; Bhatia BD Source: Singapore Medical Journal. 2008 Jul;49(7):556-60. Abstract: INTRODUCTION: Very low birth weight (VLBW) neonates constitute approximately 4-7 percent of all live births and their mortality is very high. The objective of the present study was to determine the predictors of mortality in VLBW neonates. METHODS: A retrospective cohort of VLBW neonates admitted over three years was studied. Exclusion criteria were: (1) neonates weighing less than 500 g and with gestational age less than 26 weeks; (2) presence of lethal congenital malformations; and (3) death in the delivery room or within 12 hours of life. The outcome measure was in-hospital death. Medical records were reviewed and data was analysed. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. RESULTS: A total of 260 cases were enrolled, of which a total of 96 (36.9 percent) babies died. The survival rate was found to increase with the increase in birth weight and gestational age. Univariate analysis showed maternal per vaginal bleeding, failure to administer steroid antenatally, Apgar score less than or equal to 5 at one minute, apnoea, gestational age, neonatal septicaemia and shock are the factors directly responsible for neonatal mortality. Logistic regression equation showed maternal bleed (1.326), apnoea (3.159), birth weight (0.037), gestational age (0.063), hypothermia (1.132) and shock (3.49) predicted 65 percent of mortality in VLBW babies. CONCLUSION: Common antenatal and perinatal predictors of mortality in VLBW infants in India include maternal bleed, failure to administer antenatal steroids, low Apgar score, apnoea, extreme prematurity, neonatal septicaemia and shock. Language: English Keywords: INDIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COHORT ANALYSIS | STATISTICAL REGRESSION | RETROSPECTIVE STUDIES | INFANT | PREVALENCE | RISK FACTORS | LOW BIRTH WEIGHT | PREGNANCY OUTCOMES | NEONATAL MORTALITY | GESTATIONAL AGE | TOXIC SHOCK SYNDROME | Developing Countries | Asia, Southern | Asia | Research Methodology | Data Analysis | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Biology | Birth Weight | Body Weight | Physiology | Pregnancy | Reproduction | Infant Mortality | Mortality | Population Dynamics | Fetus | Infections | Diseases Document Number: 328997 |
| 10. Peer Reviewed Title: Predictors of age at menarche in the Newcastle Thousand Families Study. Author: Blell M; Pollard TM; Pearce MS Source: Journal of Biosocial Science. 2008 Jul;40(4):563-575. Abstract: Several studies have found relationships between early life factors (birth weight, length of gestation, height, weight, duration of breast-feeding, maternal age, social class, periods of infection, presence of adverse life events, and quality of housing conditions in childhood) and age at menarche but none has considered all of these factors in the same study. The follow-up study of the Newcastle Thousand Families birth cohort, established in 1947, provided age at menarche data collected retrospectively at age 50 from 276 women who returned self-completion questionnaires in 1997. Three main independent associations were observed: girls who experienced a shorter gestation, girls whose mothers were younger when they were born, and girls who were heavier at age 9 had earlier menarche. Birth weight, standardized for gestational age, was found to have different relationships with age at menarche depending upon how heavy or light a girl was at age 9. The results of this study support the hypotheses thatconditions in fetal and early life are associated with the timing of menarche and that greater childhood growth is associated with earlier menarche. It is suggested that future work should focus on illuminating the mechanisms underlying these statistical relationships. (author's) Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | RETROSPECTIVE STUDIES | MOTHERS | ADOLESCENTS, FEMALE | YOUTH | AGE FACTORS | MENARCHE | BIRTH WEIGHT | GESTATIONAL AGE | BODY WEIGHT | CHILD DEVELOPMENT | QUALITY OF LIFE | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Adolescents | Population Characteristics | Demographic Factors | Population | Menstruation | Reproduction | Physiology | Biology | Fetus | Pregnancy | Social Welfare | Economic Factors Document Number: 327238 |
| 11. Peer Reviewed Title: Exposure to misoprostol and hormones during pregnancy and risk of congenital anomalies. Author: Dal Pizzol TD; Sanseverino MT; Mengue SS Source: Cadernos de Saude Publica. 2008 Jun;24(6):1447-1453. Abstract: This study evaluated the association between use of misoprostol and other drugs to induce menstruation, and congenital anomalies. A sample of 4,856 pregnant women 20 years and older were enrolled consecutively in prenatal services in the Unified National Health System, in six Brazilian State capitals. Data on socio-demographics and use of medicines were obtained using an interview from the 21st to 28th week of pregnancy. Other data, including information on delivery and diagnosis of congenital anomalies by the attending neonatal physician were obtained from patient charts. Potential confounders were adjusted by logistic regression. Use of drugs to induce menstruation was reported by 707 women (14.6%), of whom 120 (17%) reported use of misoprostol. After adjusting for the study center, a positive association was observed between misoprostol and congenital anomalies (OR = 2.64; 95%CI: 1.03-6.75); a positive association was also observed for sex hormones (OR = 2.24; 95%CI: 1.06-4.74). The results suggest that the use of misoprostol or sex hormones during pregnancy increases the risk of congenital anomalies. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | MISOPROSTOL | GESTATIONAL AGE | ABORTION | CONGENITAL ABNORMALITIES | Developing Countries | South America, Eastern | South America | Latin America | Americas | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Fetus | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Neonatal Diseases and Abnormalities | Diseases Document Number: 327454 Notification |
| 12. Title: Abortion surveillance--United States, 2005. Author: Gamble SB; Strauss LT; Parker WY; Cook DA; Zane SB; Hamdan S Source: MMWR. Surveillance Summaries. 2008 Nov 28;57(13):1-32. Abstract: PROBLEM/CONDITION: CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. REPORTING PERIOD COVERED: This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2005. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. Information is requested each year from all 50 states, New York City, and the District of Columbia. For 2005, data were received from 49 reporting areas: New York City, District of Columbia, and all states except California, Louisiana, and New Hampshire. For the purpose of trends analysis, data were evaluated from the 46 reporting areas that have been consistently reported since 1995. RESULTS: A total of 820,151 legal induced abortions were reported to CDC for 2005 from 49 reporting areas, the abortion ratio (number of abortions per 1,000 live births) was 233, and the abortion rate was 15 per 1,000 women aged 15--44 years. For the 46 reporting areas that have consistently reported since 1995, the abortion rate declined during 1995--2000 but has remained unchanged since 2000. For 2005, the highest percentages of reported abortions were for women who were known to be unmarried (81%), white (53%), and aged <25 years (50%). Of all abortions for which gestational age was reported, 62% were performed at 15 weeks' gestation (3.7% at 16--20 weeks and 1.3% at >/=21 weeks). A total of 35 reporting areas submitted data stating that they performed and enumerated medical (nonsurgical) procedures, making up 9.9% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. In 2004 (the most recent years for which data are available), seven women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion. INTERPRETATION: For the 46 reporting areas that have consistently reported since 1995, the number of abortions has steadily declined over the previous 10 years. The abortion rate declined from 1995 to 2000, but remained unchanged since 2000. In 2004, as in the previous years, deaths related to legal induced abortions occurred rarely. PUBLIC HEALTH ACTION: Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and evaluate efforts to prevent unintended pregnancies. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL STUDIES | WOMEN | ABORTION | CDC | HUMAN GEOGRAPHY | ABORTION RATE | PUBLIC HEALTH | MARITAL STATUS | AGE FACTORS | GESTATIONAL AGE | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | USPHS | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Geography | Social Sciences | Science | Health | Nuptiality | Population Characteristics | Fetus | Pregnancy | Reproduction Document Number: 329496 Notification |
| 13. Title: Self-reported illness and birth weight in the Philippines: implications for hypotheses of adaptive fetal plasticity. Author: Heinke D; Kuzawa CW Source: American Journal of Human Biology. 2008 Sep-Oct;20(5):538-44. Abstract: It has been proposed that prenatal nutrition provides the fetus with a cue allowing it to adjust biological settings in anticipation of postnatal nutrition. To evaluate the reliability of fetal growth rate as a nutritional cue, this study assesses the extent to which a nonnutritional factor-maternal illness symptoms during pregnancy-predicts birth outcomes in a large, population-based sample of Filipino women and their newborns (n = 2,887). Self-reported illness symptoms were collected during pregnancy and used to predict weight, length, BMI, and gestational age at birth. Independent of potential confounders, number of reported symptoms predicted a significant dose-response decrease in birth weight and BMI, but not length that reflected a combination of reduced fetal growth rate and reduced duration of gestation. These effects were comparable in male and female offspring, but tended to be stronger when reported closer to term. Among women interviewed at 32 weeks gestation or later, multiple symptoms predicted a 144 g birth weight reduction compared with no symptoms. These findings suggest an acute effect of maternal illness on fetal nutrition late in gestation when growth rate and fat deposition are most rapid. Although modest, the effect was larger than that of most pregnancy macronutrient supplementation trials. These findings using crosssectional, self-reported illness symptoms highlight a nonnutritional maternal influence on fetal nutrition, which could attenuate its value as a cue of postnatal ecology. Language: English Keywords: PHILIPPINES | RESEARCH REPORT | PREGNANT WOMEN | PREGNANCY | INFANT | MATERNAL NUTRITION | BIRTH WEIGHT | GESTATIONAL AGE | SIGNS AND SYMPTOMS | Developing Countries | Asia, Southeastern | Asia | Population Characteristics | Demographic Factors | Population | Reproduction | Youth | Age Factors | Nutrition | Health | Body Weight | Physiology | Biology | Fetus | Diseases Document Number: 328654 |
| 14. Title: Fetal gender screening by ultrasound at 11 to 13 +6 weeks. Author: Hsiao CH; Wang HC; Hsieh CF; Hsu JJ Source: Acta Obstetricia et Gynecologica Scandinavica. 2008;87(1):8-13. Abstract: The objective was to survey the accuracy of fetal gender determination during first trimester screening and scan for congenital anomalies. A prospective observational study was performed on 496 singleton pregnancies at the first trimester ultrasound screening. The doctor was a certified sonographer of first trimester screening by the Fetal Medicine Foundation (FMF). Ultrasound examination was performed on a GE Voluson 730 Pro, transabdominally, between 11 and 13/+6 weeks. Both transverse and mid-sagittal planes of a section of the fetal genital tubercle were performed to identify the gender. The subsequent gender at birth was obtained from karyotyping reports or hospital birth records. During the study, 496 patients requested gender information at the time of first trimester screening. Of the patients it was possible to determine gender (441 out of 496), the scan achieved an overall success rate of 91.8% in correctly identifying gender. The success rate for correctly identifying fetal gender (where identification was possible) increased with gestational age, from 71.9% at 11 weeks, 92% at 12 weeks, and 98.3% at 13 weeks, respectively, where gestational age was calculated from the crown-rump length in conjunction with menstrual or ovulation dating (p less than 0.001). Of the 55 cases where no identification of gender was possible, 39 were in the 11-week gestational age group, representing 40.6% of this category. The overall fetal gender accuracy rate for male fetus was slightly better than female (92.5 versus 91.2%), but was not statistically significant. This study demonstrated that the gestational age of the fetus has a material effect on the accuracy rate of gender determination. At 12 weeks and over, the average success rate for correctly identifying gender, where gender identification was possible, was 94.8%, with the accuracy at 13 weeks of 98.3% approaching that achieved by invasive testing. Fetal gender identification at 11 weeks (where crown-rump length is less than 57 mm) is difficult and liable to high rates of inaccuracy when a determination is made. (author's) Language: English Keywords: TAIWAN | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | SEX DETERMINATION | SCREENING | ULTRASONICS | CONGENITAL ABNORMALITIES | PREGNANCY, FIRST TRIMESTER | RELIABILITY | GESTATIONAL AGE | Asia, Eastern | Asia | Developed Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Genetic Techniques | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Neonatal Diseases and Abnormalities | Diseases | Pregnancy | Reproduction | Measurement | Fetus Document Number: 325876 |
| 15. Peer Reviewed Title: Abortion in the United States: Incidence and access to services, 2005. Author: Jones RK; Zolna MR; Henshaw SK; Finer LB Source: Perspectives on Sexual and Reproductive Health. 2008 Mar;40(1):6-16. Abstract: Accurate information about abortion incidence and services is necessary to monitor levels of unwanted pregnancy and women's ability to access abortion services. All known abortion providers in the United States were contacted for information about abortion services in 2004 and 2005. This information, along with data from the U.S. Census Bureau, was used to examine national and state trends in numbers of abortions and abortion rates, proportions of counties and metropolitan areas without an abortion provider, and accessibility of abortion services. An estimated 1.2 million abortions were performed in the United States in 2005, 8% fewer than in 2000. The abortion rate in 2005 was 19.4 per 1,000 women aged 15-44; this rate represents a 9% decline from 2000. There were 1,787 abortion providers in 2005, only 2% fewer than in 2000. Some 87% of U.S. counties, containing 35% of women aged 15-44, did not have an abortion provider in 2005. Early medication abortion, offered by an estimated 57% of known providers, accounted for 13% of abortions (and for 22% of abortions before nine weeks' gestation). The average amount paid for an abortion at 10 weeks was $413-after adjustment for inflation, $11 less than in 2001. The numbers of abortions and the abortion rate continued their long-term decline through 2005. Reasons for this trend are unknown but may include improved access to and use of contraceptives or decreased access to abortion services. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | SURVEYS | WOMEN | ABORTION RATE | ABORTION | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | INCIDENCE | CENSUS | FAMILY PLANNING SURVEYS | GESTATIONAL AGE | FEES | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Program Evaluation | Programs | Organization and Administration | Health | Measurement | Population Statistics | Health Facilities | Fetus | Pregnancy | Reproduction | Financial Activities | Economic Factors Document Number: 325186 Notification |
| 16. Title: Chloroquine pharmacokinetics in pregnant and nonpregnant women with vivax malaria. Author: Lee SJ; McGready R; Fernandez C; Stepniewska K; Paw MK; Viladpai-nguen SJ; Thwai KL; Villegas L; Singhasivanon P; Greenwood BM; White NJ; Nosten F Source: European Journal of Clinical Pharmacology. 2008 Oct;64(10):987-92. Abstract: PURPOSE: We compared the pharmacokinetics of chloroquine in pregnant and nonpregnant women treated for Plasmodium vivax malaria. METHODS: Twelve pregnant women and 15 nonpregnant women of child-bearing age with acute P. vivax malaria were treated with 25 mg chloroquine base/kg over 3 days on the northwestern border of Thailand. Blood concentrations of chloroquine and desethylchloroquine were measured using hydrophilic interaction liquid chromatography coupled with fluorescence detection. Twenty-five women completed the pharmacokinetic study. RESULTS: Although increasing gestational age was associated with reduced chloroquine AUC0-->infinity, there was no significant difference overall in the pharmacokinetics of chloroquine between pregnant and nonpregnant women. Fever was associated with lower chloroquine AUC0-->infinity values. Desethylchloroquine area under the curve (AUC) values were not significantly affected by pregnancy. CONCLUSIONS: Pregnancy did not significantly affect blood concentrations of chloroquine or its metabolite, desethylchloroquine, in women with P. vivax malaria. Language: English Keywords: THAILAND | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MALARIA | GESTATIONAL AGE | ANTIMALARIAL DRUGS | METABOLIC EFFECTS | Developing Countries | Asia, Southeastern | Asia | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Fetus | Pregnancy | Reproduction | Physiology | Biology Document Number: 329254 |
| 17. Peer Reviewed Title: Estimation of individual neonatal survival using birthweight and gestational age: A way to improve neonatal care. Author: Mardones F; Marshall G; Viviani P; Villarroel L; Burkhalter BR Source: Journal of Health, Population and Nutrition. 2008 Mar;26(1):54-63. Abstract: The study was conducted to determine the combined effect of birthweight and gestational age at birth on neonatal mortality using individually-identified livebirths. Logistic regression was used for studying the interactive effect of birthweight and gestational age on the individual probability of neonatal death. All livebirths from Chile in 2000 were included in a linked file. Odds ratio models for birthweight and gestational age were developed for each sex. The probability of neonatal death by sex was presented using contour plots. The models were statistically significant, and odds ratios were different and non-linear for the effects of birthweight and gestational age. Contour plots of constant neonatal mortality according to birthweight and gestational age were presented; they were similar for each sex. A single graph for both sexes that estimates the survival potential of infants born too early or too small would improve neonatal care in developing countries. (author's) Language: English Keywords: CHILE | RESEARCH REPORT | ESTIMATION TECHNIQUES | STATISTICAL REGRESSION | MATHEMATICAL MODEL | INFANT | BIRTH WEIGHT | GESTATIONAL AGE | NEONATAL MORTALITY | PERFORMANCE IMPROVEMENT | MORTALITY DETERMINANTS | PROBABILITY | SEX FACTORS | Developing Countries | South America, Southern | South America | Latin America | Americas | Research Methodology | Data Analysis | Theoretical Models | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Body Weight | Physiology | Biology | Fetus | Pregnancy | Reproduction | Infant Mortality | Mortality | Population Dynamics | Management | Organization and Administration | Statistical Studies | Studies Document Number: 308652 |
| 18. Peer Reviewed Title: Establishment of reference range for thyroid hormones in normal pregnant Indian women. Author: Marwaha RK; Chopra S; Gopalakrishnan S; Sharma B; Kanwar RS Source: BJOG: An International Journal of Obstetrics and Gynaecology. 2008 Apr;115(5):602-606. Abstract: Interpretation of thyroid function tests during pregnancy needs trimester-related reference intervals from pregnant populations with minimal risk for thyroid dysfunction. While India has become iodine sufficient after two decades of salt iodisation, there is no normative data for thyroid function from healthy pregnant women of this country. The objectives were to determine trimester-specific reference ranges for free triiodothyronine (FT3), free thyroxine (FT4) and thyrotropin (TSH) from healthy pregnant Indian women. The design was a cross-sectional study in a reference population of pregnant women. The setting was a primary care level obstetric department in India. The population used in the study were women with uncomplicated pregnancy in any trimester. Five hundred and forty-one apparently healthy pregnant women with uncomplicated single intrauterine gestations reporting to the Armed Forces Clinic in any trimester were consecutively recruited. Clinical examination, thyroid ultrasound for echogenicity and nodularity and estimation of FT3, FT4, TSH and antithyroid antibodies (antithyroperoxidase [anti-TPO] and antithyroglobulin [anti-Tg]) using electrochemiluminescence technique were carried out. From this entire sample, a disease- and risk-free reference population was obtained by excluding those with any known factor that could affect thyroid function or those who were being treated for thyroid dysfunction. Of the 541 consecutive pregnant women in different trimesters enrolled for the study, 210 women were excluded. The composition of reference population comprising 331 women was 107 in first trimester, 137 in second trimester and 87 in third trimester. The 5th and 95th percentiles values were used to determine the reference ranges for FT3, FT4 and TSH. The trimester-wise values in the first, second and third trimesters were: FT3 (1.92-5.86, 3.2-5.73 and 3.3-5.18 pM/l), FT4 (12-19.45, 9.48-19.58 and 11.32-17.7 pM/l) and TSH (0.6-5.0, 0.44-5.78 and 0.74-5.7 i/ml), respectively. Analysis of mean, median values for FT3, FT4 and TSH between each trimester showed no significant difference in FT3 and TSH values (95% CI). However, FT4 showed significant variation between trimesters with values decreasing with advancing gestational age (P value: first versus second = 0.015, first versus third = 0.003 and second versus third = not significant). Women with antibody positivity and hypoechogenicity of thyroid gland had significantly higher TSH values when compared with women with antibody negativity and normoechogenicity. Reference ranges of FT3, FT4 and TSH have been established for pregnant Indian women using 5th and 95th percentiles. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | HORMONES | GESTATIONAL AGE | HEMATOLOGICAL EFFECTS | Developing Countries | Asia, Southern | Asia | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Endocrine System | Physiology | Biology | Fetus | Pregnancy | Reproduction | Hemic System Document Number: 325247 |
| 19. Title: Puerperal Clostridium perfringens sepsis in a patient with granulocytopenia. Author: Nadisauskiene RJ; Kliucinskas M; Vitkauskiene A; Minkauskiene M; Vaitkiene D Source: Gynecologic and Obstetric Investigation. 2008 Jan;65(1):32-34. Abstract: Over the past three decades puerperal sepsis due to Clostridium perfringens has become a particularly rare condition in obstetrical practice but it is still associated with a high maternal mortality . C. perfringens is a widespread microorganism that can be found in soil, the normal human gastrointestinal tract, and skin. C. perfringens has been isolated in the vagina or cervix of 1-10% of healthy women. The rapid spread of infection requires devitalized tissues under anaerobic conditions and a low immune response of the organism. Nowadays gas gangrene caused by C. perfringens develops intra-abdominally or in the soft tissues of immunocompromised patients with trauma, hematological and gastrointestinal malignancies, diabetes mellitus, and alcoholism or drug abuse. It is a rapidly progressive, life-threatening condition with necrosis of muscle, gas formation (primarily insoluble hydrogen and nitrogen), and associated systemic manifestations (hypotension, renal failure, and hemolysis). Uterine gas gangrene was more common before abortion legislation, but since the introduction of antibiotic therapy and legal abortions it has become a rare event. Survival depends on extremely early diagnosis and appropriate treatment. In this report, we present a lethal case of fulminant puerperal sepsis with massive hemolysis after cesarean section in a patient with intermittent granulocytopenia. (excerpt) Language: English Keywords: LITHUANIA | RESEARCH REPORT | PREGNANT WOMEN | GESTATIONAL AGE | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | PREGNANCY COMPLICATIONS | CESAREAN SECTION | HEMATOLOGICAL EFFECTS | BACTERIAL AND FUNGAL DISEASES | INFECTIONS | Developing Countries | Europe, Eastern | Europe | Population Characteristics | Demographic Factors | Population | Fetus | Pregnancy | Reproduction | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Treatment | Hemic System | Physiology | Biology Document Number: 323123 |
| 20. Peer Reviewed Title: Decreased waiting periods in a public pregnancy termination clinic. Author: Patel A; Panchal H; Patel R; Keith L Source: Contraception. 2008 Feb;77(2):105-107. Abstract: In our public hospital, first-trimester pregnancy termination historically had been performed in an operating room by suction curettage on a separate day following the initial clinic visit. To increase efficiency, we instituted three changes over a 2-year period: (a) pregnancy termination procedures were relocated to the outpatient area; (b) same-day service was initiated; and (c) manual vacuum aspiration was introduced. Our primary objective was to assess the effects of these changes on the waiting period in days from the intake visit to the day of termination procedure. Our secondary objectives included assessing any decrease in gestational age at the time of procedure, increases in the numbers of procedures at less than 9 weeks, the numbers of procedures per session and the proportion done on the day of intake. This is a retrospective cross-sectional review of the clinical records of patients who requested pregnancy termination. Data were obtained on 625 patients who underwent a surgical termination of pregnancy from February 1, 2004, to January 31, 2006. The waiting period decreased from 20.3 to 3.6 days (p less than .01), and mean gestational age at termination decreased from 11 to 9 weeks (p less than .01). The proportion at less than 9 weeks' gestation increased from 1.7% to 40% (p less than .01). The number of procedures per session increased by 52.7% (p less than .01). The percentage of same-day procedures increased from 7% to 62%. We improved efficiency of care by reducing the waiting period and terminating pregnancies earlier in gestation with manual equipment. (author's) Language: English Keywords: UNITED STATES OF AMERICA | ILLINOIS | RESEARCH REPORT | RETROSPECTIVE STUDIES | ABORTION | HOSPITALS | PROGRAM EFFICIENCY | GESTATIONAL AGE | CLINIC VISITS | Developed Countries | North America | Americas | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Health Facilities | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Fetus | Pregnancy | Reproduction | Service Statistics | Program Activities Document Number: 324408 Notification |
| 21. Title: Birthweight percentiles by gestational age and gender for children in the North of Mexico. Author: Ríos JM; Tufiño-Olivares E; Reza-López S; Sanín LH; Levario-Carrillo M Source: Paediatric and Perinatal Epidemiology. 2008 Mar;22(2):188-194. Abstract: The objective of this study was to determine the 10th, 50th and 90th percentiles of birthweight, by gestational age and sex, for newborns covered by the Mexican Institute of Social Security (IMSS) in the State of Chihuahua. To generate the database, we used IMSS hospitals' records in the State of Chihuahua, covering the period between 1 January 2000 and 31 December 2004. We included singleton live births only, and excluded babies with congenital malformations. The birthweights of 88 368 children born at 21-44 weeks of gestation comprised our data. From these data, we calculated the 10th, 50th and 90th percentiles for each sex, at 32-44 weeks of gestation. The observed cutoffs for the 10th percentile in our population were 40-250 g higher than those reported in other references with Mexican populations. These results constitute an updated birthweight reference that will allow the identification of newborns in the North region of the country with low birthweight-for-gestational age. Such informationcan be a useful instrument for preventing or diminishing associated risks. (author's) Language: English Keywords: MEXICO | RESEARCH REPORT | RETROSPECTIVE STUDIES | INFANT | BIRTH WEIGHT | GESTATIONAL AGE | SEX FACTORS | North America | Americas | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Body Weight | Physiology | Biology | Fetus | Pregnancy | Reproduction Document Number: 324888 |
| 22. Peer Reviewed Title: Drug-prescribing patterns during pregnancy in the tertiary care hospitals of Pakistan: a cross sectional study. Author: Rohra DK; Das N; Azam SI; Solangi NA; Memon Z Source: BMC Pregnancy and Childbirth. 2008 Jul 15;8(24):[21] p. Abstract: The rationale for use of drugs during pregnancy requires a careful assessment as in addition to the mother, the health and life of her unborn child is also at stake. Information on the use of drugs during pregnancy is not available in Pakistan. The aim of this study was to evaluate the patterns of drug prescriptions to pregnant women in tertiary care hospitals of Pakistan. METHODS: This was a cross-sectional study conducted at five tertiary care hospitals of Pakistan. Copies of outpatient medicinal prescriptions given to pregnant patients attending the antenatal clinics were collected. The drugs were classified according to the pharmacological class and their teratogenic potential. RESULTS: All the pregnant women attending the antenatal clinics received a prescription containing at least one drug. A total of 3769 distinct prescriptions given to different women were collected. Majority of the women who received the prescriptions belonged to third trimester (55.4%) followed by second (33.6%) and first trimester (11.0%). On an average, each prescription contained 1.66 +/- 0.14 drugs. The obstetricians at Civil Hospital, Karachi and Chandka Medical College Hospital, Larkana showed a tendency of prescribing lesser number of drugs compared to those in other hospitals. Anti-anemic drugs including iron preparations and vitamin and mineral supplements (79.4%) were the most frequently prescribed drugs followed by analgesics (6.2%) and anti-bacterials (2.2%). 739 women (19.6%) received prescriptions containing drugs other than vitamin or mineral supplements. Only 1275 (21.6%) of all the prescribed drugs (n = 6100) were outside this vitamin/mineral supplement class. Out of these 1275 drugs, 29 (2.3%) drugs were prescribed which are considered to be teratogenic. Misoprostol was the most frequently prescribed (n = 6) among the teratogenic drugs followed by carbimazole (n = 5) and methotrexate (n = 5). Twenty nine pregnant women (0.8% of all the women studied) were prescribed these teratogenic drugs. CONCLUSION: Less than one percent of the pregnant women attending tertiary care hospitals in Pakistan are prescribed teratogenic drugs. The prescribing practices of Pakistani physicians are similar to those in western countries. Language: English Keywords: PAKISTAN | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | OPERATIONS RESEARCH | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | HOSPITAL PERSONNEL | PHYSICIANS | HOSPITALS | PRESCRIPTIONS | ANTENATAL CARE | GESTATIONAL AGE | OBSTETRICS | Developing Countries | Asia, Southern | Asia | Research Methodology | Program Evaluation | Programs | Organization and Administration | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Health Facilities | Distributional Activities | Program Activities | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Fetus | Pregnancy | Reproduction | Medicine Document Number: 327749 |
| 23. Peer Reviewed Title: Infant mortality in three population-based cohorts in Southern Brazil: trends and differentials. Author: Santos IS; Menezes AM; Mota DM; Albernaz EP; Barros AJ; Matijasevich A; Barros FC; Victora CG Source: Cadernos de Saude Publica. 2008;24 Suppl 3:S451-60. Abstract: We studied time trends in infant mortality and associated factors between three cohort studies carried out in Pelotas, Rio Grande do Sul State, Brazil, in 1982, 1993, and 2004. All hospital births and deaths were determined by means of regular visits to hospitals, registrar's offices, and cemeteries. This data was used to calculate neonatal, post-neonatal, and infant mortality rates per thousand live births. Rates were also calculated according to cause of death, sex, birth weight, gestational age, and family income. The infant mortality rate fell from 36.4 per 1,000 live births in 1982 to 21.1 in 1993 and 19.4 in 2004. Major causes of infant mortality in 2004 were perinatal causes and respiratory infections. Mortality among low birth weight children from poor families fell 16% between 1993 and 2004; however, this rate increased by more than 100% among high-income families due to the increase in the number of preterm deliveries in this group. The stabilization of infant mortality in the last decade is likely to be due to excess medical interventions relating to pregnancies and delivery care. Language: English Keywords: BRAZIL | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | INFANT | INFANT, PREMATURE | PREVALENCE | INFANT MORTALITY | LOW BIRTH WEIGHT | INCOME | NEONATAL MORTALITY | GESTATIONAL AGE | BIRTH WEIGHT | SEX FACTORS | CAUSES OF DEATH | Developing Countries | South America, Eastern | South America | Latin America | Americas | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Mortality | Population Dynamics | Body Weight | Physiology | Biology | Socioeconomic Factors | Economic Factors | Fetus | Pregnancy | Reproduction Document Number: 330448 |
| 24. Title: Fifteen years later: Adolescent mothers weigh more but their babies do not (1990 to 2005). Author: Sheeder J; Stevens-Simon C Source: Journal of Pediatric and Adolescent Gynecology. 2008 Apr;21(2):59. Abstract: American adolescents are bigger and more likely to be overweight or obese than they were two decades ago. Adult mothers and their infants have also gotten bigger. The purpose of this study was to determine if the size of pregnant adolescents and the size and maturity of their infants has changed. A racially/ethnically diverse group of 1,187, 13-through-18 year old, primigravida participants in an adolescent-oriented maternity program was enrolled consecutively between 1990 and 2005 and grouped by year of conception. Maternal outcomes were: self-reported preconception weight, measured height, body mass index (BMI; weight/height/2), and the proportion of under, average, and overweight/obese adolescents. Infant outcomes were: birth weight, gestational age, and the proportion of small, average, and large for gestational age and preterm births. Covariates included: age, race/ethnicity, smoking, pregnancy induced hypertension (PIH), abnormal glucose screen, Caesarian delivery, labor induction, and infant sex. The analysis used ANOVAs/MANOVAs. The ANOVAs revealed a significant increase in maternal weight (p = 0.006), BMI (p = 0.002), overweight/ obese status (p less than 0.0001), age (p less than 0.0001), Hispanic ethnicity (p less than 0.0001), and induced labors (p = 0.004) over the study period. There was also a significant decrease in maternal height (p less than 0.0001), PIH (p = 0.01), and Caucasian adolescents (p less than 0.0001). None of the infant outcome measures or other covariates changed significantly over the 15 years. Following adjustment for significant covariates (age and race/ ethnicity), the increase in maternal weight and decrease in height remained statistically significant (p = 0.04 and 0.01, respectively). None of the other maternal or infant outcome measures changed significantly. The weight of adolescent mothers has increased over the past 15 years but neither the weight of their infants nor the proportion of small-for-gestational age and preterm births has changed. The findings arereminiscent of the results of studies demonstrating that adolescents give birth to smaller infants than same-sized adults and transfer less of the weight they gain during gestation to their fetuses. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | ADOLESCENTS, FEMALE | MOTHERS | ADOLESCENT PREGNANCY | BODY WEIGHT | BODY HEIGHT | BIRTH WEIGHT | GESTATIONAL AGE | PREMATURE BIRTH | Developed Countries | North America | Americas | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Reproductive Behavior | Fertility | Population Dynamics | Physiology | Biology | Fetus | Pregnancy | Reproduction | Pregnancy Outcomes Document Number: 325882 |
| 25. Peer Reviewed Title: Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction (MPR). Author: Stone J; Ferrara L; Kamrath J; Getrajdman J; Berkowitz R; Moshier E; Eddleman K Source: American Journal of Obstetrics and Gynecology. 2008 Oct;199(4):406.e1-4. Abstract: OBJECTIVE: This study was undertaken to report on the outcome of multifetal pregnancy reduction in the most up-to-date largest single center experience with this procedure, and compare the outcome to the first 1000 cases performed at the same institution. STUDY DESIGN: 1000 consecutive cases of multifetal pregnancy reduction performed at the Mount Sinai Medical Center between the years 1999-2006 were identified. Pregnancy outcomes were retrieved from a large database as well as chart review. Differences in means and proportions were evaluated by analysis of variance, chi-square, Cochran-Armitage test for trend or 2-tailed Fisher exact test as appropriate. RESULTS: Outcomes were available on 841 cases, for a follow-up rate of 84.1%; 95.2% of patients delivered after 24 weeks, for a complete loss rate of 4.7%. There was a significant trend toward decreasing loss rates with decreasing starting numbers. Mean gestational age at delivery was later, and birthweights greater, for reduction to singletons vs twins. CONCLUSION: Loss rates after multifetal pregnancy reduction have remained stable at 4.7%. The lowest loss rate occurred in the patients reducing from twins to a singleton (2.1%). Reduction to a singleton was also associated with higher birthweights and lower rates of preterm deliveries. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | DATA ANALYSIS | PREGNANCY OUTCOMES | MULTIPLE BIRTH | GESTATIONAL AGE | BIRTH WEIGHT | Developed Countries | North America | Americas | Research Methodology | Pregnancy | Reproduction | Fetus | Body Weight | Physiology | Biology Document Number: 329075 |
| 26. Title: A centile chart for fetal weight for gestational ages 24 - 27 weeks [letter] Author: Theron GB; Geerts L; Thompson ML; Theron AM Source: South African Medical Journal. 2008 Apr;98(4):270-271. Abstract: The centile chart currently in use for Western Cape birth weight for gestational age covers a gestational age range from 28 to 42 weeks. Advances in maternal, fetal and neonatal medicine allow interventions prior to 28 weeks; a growing need therefore exists to extend the chart down to at least 24 weeks. Birth or fetal weight centile charts used in the USA, Canada and the UK provide centiles commencing from either 22 or 24 weeks. These charts may not, however, be appropriate for the population of the Western Cape. The accuracy of fetal or birth weight for gestational age centile charts can be improved by including only women who had their gestational age confirmed by early ultrasound prior to gestational age of 24 weeks. In addition, the birth weight of preterm delivered neonates should not be used to establish a norm, as these infants were delivered following maternal and/or obstetric complications. The ultrasonic estimated fetal weight (EFW) is the method of choice to establish a reference range for weight for gestational age in early gestation. The EFW should be used in preference to any single ultrasound measurement as it relies on multiple measurements. The aim of this study was to construct a centile chart from 24 to 27 weeks for fetal weight for gestational age, taking the above criteria into account. (excerpt) Language: English Keywords: SOUTH AFRICA | METHODOLOGICAL STUDIES | TABLES AND CHARTS | ESTIMATION TECHNIQUES | MEASUREMENT | EVALUATION INDEXES | COHORT ANALYSIS | FETUS | GESTATIONAL AGE | HEALTH STATUS INDEXES | PREGNANCY, THIRD TRIMESTER | BODY WEIGHT | ULTRASONICS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Pregnancy | Reproduction | Health | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 330638 |
| 27. Peer Reviewed Title: Estimation of a structural model of the determinants of neonatal mortality in Hungary, 1984 - 88 and 1994 - 98. Author: Vandresse M Source: Population Studies. 2008 Mar;62(1):85-11. Abstract: We developed and evaluated a structural model of the determinants of neonatal mortality in Hungary that embodies the causal mechanisms by which its proximate and indirect determinants - socio-economic, behavioural, and biological - are related. The statistical model used distinguishes between endogenous and exogenous variables and allows the causal effect of each to be correctly estimated. Unobserved variables are integrated into the model, which was tested using Hungarian data for the periods 1984-88 and 1994-98. The principal findings are as follows: weight at birth and duration of gestation are the most important of the (direct) causal determinants of neonatal mortality. Mother's age has an indirect and detrimental effect: when mothers are older than 30 years of age, the risk of lower birth weight or multiple births and, in consequence, neonatal mortality is increased. Father's age has no direct or indirect causal effect on neonatal mortality. (author's) Language: English Keywords: HUNGARY | THEORETICAL STUDIES | THEORETICAL MODELS | INFANT | NEONATAL MORTALITY | MORTALITY DETERMINANTS | ESTIMATION TECHNIQUES | RISK FACTORS | MATERNAL AGE | PATERNAL AGE | BIRTH WEIGHT | GESTATIONAL AGE | Developing Countries | Europe, Central | Europe | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Biology | Parental Age | Body Weight | Physiology | Fetus | Pregnancy | Reproduction Document Number: 324675 |
| 28. Title: Low birth weight, prematurity, and paternal social status: impact on the basic competence test in Taiwanese adolescents. Author: Wang WL; Sung YT; Sung FC; Lu TH; Kuo SC; Li CY Source: Journal of Pediatrics. 2008 Sep;153(3):333-8. Abstract: OBJECTIVE: To investigate whether birth weight and paternal education may have independent and interactive effects on the learning achievement of adolescents. STUDY DESIGN: We linked birth weights, gestational ages (term or preterm) and paternal education of a 4-year birth cohort to the Basic Competence Test (BCT) scores in Mandarin, mathematics and science for junior high school students age 15 to 16 years. The study groups comprised infants with term low birth weight (TLBW; n = 33 507), preterm normal birth weight (PNBW; n =19 905), and preterm low birth weight (PLBW; n = 25 840), as well as randomly selected term infants with normal birth weight (TNBW; n = 83 756). Paternal education levels were categorized. RESULTS: Compared with the TNBW adolescents, the TLBW adolescents consistently showed larger deficits in mean scores for Mandarin (beta = -2.36), mathematics (beta = -2.89), and science (beta = -2.11). The corresponding significant deficit scores for the PLBW adolescents were -1.93, -2.80, and -1.92. The deficit scores were very small for the PNBW adolescents. Paternal education was inversely associated with scores of all 3 groups. Lower paternal education level tended to worsen the negative impact of low birth weight on BCT scores. CONCLUSIONS: Both lower birth weight and lower paternal education exert an independent and interactive effect on adolescent learning achievement. Language: English Keywords: TAIWAN | RESEARCH REPORT | RETROSPECTIVE STUDIES | FOLLOW-UP STUDIES | INFANT, PREMATURE | SOCIAL PROBLEMS | PREGNANCY | LOW BIRTH WEIGHT | PREMATURE BIRTH | GESTATIONAL AGE | PARENTS | EDUCATIONAL STATUS | ADOLESCENTS | INTELLIGENCE | BEHAVIOR | EMOTIONS | Asia, Eastern | Asia | Developed Countries | Studies | Research Methodology | Infant | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Sociocultural Factors | Reproduction | Birth Weight | Body Weight | Physiology | Biology | Pregnancy Outcomes | Fetus | Family Relationships | Family Characteristics | Family and Household | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Personality | Psychological Factors Document Number: 328361 |
| 29. Title: Improving access to safe abortion care and services in northern Karnataka, India. Author: Pathfinder International Source: Watertown, Massachusetts, Pathfinder International, 2007 Aug. [3] p. Abstract: Pathfinder commissioned a baseline study prior to the implementation of project activities and a midterm assessment after about a year of implementation. The study sought to: Understand the extent to which public- and private-sector medical providers offer abortion services and follow National Government of India standard protocols for abortion services; Understand the extent of community awareness regarding the prevalence of abortion, the importance of seeking an abortion early in pregnancy, methods of abortion, and location of and access to abortion services; and Ascertain the timing and cost of abortion, use of postabortion contraception, and complications due to abortion experienced by women who had recently undergone abortion. (excerpt) Language: English Keywords: INDIA | PROGRESS REPORT | HEALTH SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | ABORTION | PROGRAM ACCESSIBILITY | PERFORMANCE IMPROVEMENT | DELIVERY OF HEALTH CARE | STANDARDIZATION | PREVALENCE | COMMUNITY PARTICIPATION | GESTATIONAL AGE | CONTRACEPTIVE PREVALENCE | Developing Countries | Asia, Southern | Asia | Health | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Program Evaluation | Programs | Organization and Administration | Management | Data Adjustment | Research Methodology | Measurement | Fetus | Pregnancy | Reproduction | Contraceptive Usage | Contraception Document Number: 321286 Notification |
| 30. Title: Alterations in the 'local umbilical cord blood renin-angiotensin system' during pre-eclampsia. Author: Acar K; Beyazit Y; Sucak A; Haznedaroglu IC; Aksu S Source: Acta Obstetricia et Gynecologica Scandinavica. 2007;86(10):1193-1199. Abstract: Local autocrine-paracrine renin-angiotensin system (RAS), independently functioning from the circulating RAS, is present in major organs of the female reproductive tract. We have previously demonstrated 'a local RAS in human umbilical cord' via verifying the corresponding ACE, renin, and angiotensinogen mRNAs. The aim of this study is to search alterations of the local umbilical cord RAS during pre-eclampsia. Cord blood samples were obtained from 19 patients with pre-eclampsia (aged mean 26.60 +or- 5.83 (range 18-42) years) and 20 women with normal pregnancy (aged mean 28.26 +or- 7.30 (range 19-37) years). Women with uncomplicated pregnancy formed the control group. Real time quantitative PCR analysis for ACE, renin and angiotensinogen gene expressions were carried out using a LightCycler instrument. The mean expression ratios were 0.0029 +or- 0.0015 for renin, 0.153 +or- 0.166 for angiotensinogen, and 0.220 +or- 0.294 for ACE, in control samples. The mean expression ratios of pre-eclamptic patients were 0.006190.00068, 0.035 +or- 0.008, and 0.030 +or- 0.006 for renin, angiotensinogen and ACE genes, respectively. While renin expressions increased in the local cord blood of pre-eclampsia in comparison to the normal cord blood, unpredictable decrements in the angiotensinogen and ACE expressions were observed within the same pre-eclamptic samples. There were no statistically significant differences between intrauterine growth restriction (IUGR) and appropriate for gestational age (AGA) newborns in respect to renin, angiotensinogen and ACE gene expressions. These findings indicate that the gene expression in the major components of the local RAS does not represent a constant mathematical model, but is affected from the ongoing pathobiological events associated with the disease course. Local umbilical cord blood RAS alterations at the basis of genetic expression are evident in pre-eclampsia. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | CLINICAL RESEARCH | GENETIC TECHNIQUES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | RENIN-ANGIOTENSIN-ALDOSTERONE EFFECTS | PREECLAMPSIA | GENETICS | INTRAUTERINE GROWTH RETARDATION | GESTATIONAL AGE | |