Maternal obesity as an independent risk factor for caesarean delivery

The present study was aimed to investigate pregnancy outcome among obese women and specifically the correlation between maternal obesity and incidence of caesarean section (CS) while controlling for the potential confounding effects of other variables associated with obesity. A population-based study was performed comparing all pregnancies of obese (maternal pre-pregnancy body mass index (BMI) of 30 kg/m2 or more) and non-obese patients, between the years 1988 and 2002. Patients with hypertensive disorders and diabetes mellitus as well as patients lacking prenatal care were excluded from the analysis. Stratified analyses, using the Mantel-Haenszel technique, and a multiple logistic regression model were performed to control for confounders. During the study period there were 126,080 deliveries meeting the inclusion criteria, of which 1769 (1.4%) occurred in obese patients. Using a multivariable analysis, the following conditions were significantly associated with maternal obesity: failure to progress during the first stage (odds ratio (OR) = 3.1; 95% confidence interval [CI] 2.5, 3.8; P < 0.001), fertility treatments (OR = 2.0; [95% CI 1.6, 2.5]; P < 0.001), previous CS (OR = 1.7; [95% CI 1.5, 1.9]; P < 0.001), malpresentations (OR = 1.4; [95% CI 1.2, 1.6]; P < 0.001), recurrent miscarriages (OR = 1.4; [95% CI 1.2, 1.7]; P < 0.001) and fetal macrosomia (OR = 1.4; [95% CI 1.2, 1.7]; P < 0.001). Higher rates of caesarean deliveries were found among obese parturients (27.8% vs. 10.8%; OR = 3.2; [95% CI 2.9, 3.5]; P < 0.001). When controlling for possible confounders, using the Mantel-Haenszel technique, the association between maternal obesity and CS remained significant. No significant differences were noted between the groups regarding perinatal complications such as perinatal mortality, congenital malformations, shoulder dystocia and low Apgar scores. In conclusion, a significant association was found between obesity and CS even after the exclusion of hypertensive disorders and diabetes mellitus. Importantly, obesity alone was not associated with adverse perinatal outcome. Obstetricians should be encouraged to allow obese patients not suffering from diabetes or hypertensive disorders an adequate trial of labour.     

Maternal Nutrition and Birth Size among Urban Affluent and Rural Women in India

Background: Varying results of worldwide intervention programs to pregnant mothers necessitate the need to understand the relationship between maternal nutrition and birth size among well nourished and undernourished mothers.

Objective: To examine this relationship among urban affluent mothers and to compare the findings with those on rural Indian mothers.

Subjects: Data collected on urban affluent mothers (n = 236) was compared with rural mothers (n = 633).

Design: Mothers were contacted at 18 ± 2 and 28 ± 2 wk of gestation for anthropometry, dietary intakes [24-hr recall, Food Frequency Questionnaire (FFQ)] and after delivery for neonatal anthropometry.

Results: Despite large differences in nutritional status of urban and rural mothers ( pre-pregnant weight 55.9 ± 9.2 Vs 41.5 ± 5.2 kg, respectively) maternal fat intakes at 18 wk were associated with birth weight (p < 0.05), length (p < 0.01) and triceps skin fold thickness (p < 0.05) of the newborn in urban and rural mothers. Consumption of fruits was associated with birth length (p < 0.05) in urban (18wk) and with birth weight (p < 0.01) and length (p < 0.01) in rural (28wk) mothers, when their energy intakes were low. Maternal consumption of milk too, was associated with newborn's triceps (p < 0.01) in urban (28wk) while with birth weight (p < 0.05) and length (p < 0.05) in rural (18wk) mothers. The findings mainly underscore the importance of consumption of micronutrient rich foods, when energy intakes are limiting during pregnancy, for improving birth size.

Conclusions: Creating nutritional awareness and motivating rural mothers for consuming micronutrient rich foods like green leafy vegetables and seasonal fruits that are easily available in rural areas, will be a much affordable solution for combating the problem of low birth weight rather than waiting for improvement in the existing nationwide programs for pregnant women.     

Maternal smoking as a risk factor for childhood intussusception

Risk factors for intussusception have only rarely been reported. We examined the association between the risk of hospital admission for intussusception and maternal smoking, using a nationwide population-based longitudinal survey begun in Japan in 2010. Maternal smoking status was queried at 6 months of age, and responses to questions at 18 months of age about history of hospitalization for intussusception during the previous year were used as an outcome of interest. We conducted logistic regression analyses controlling for potential confounding factors. Maternal smoking increased the risk of hospitalization for intussusception (adjusted OR = 2.75, 95% CI [1.09, 6.96]) compared with not smoking, and a dose-response relationship was observed for the association. Maternal smoking is associated with an increased risk of intussusception development in children between the ages of 6 and 18 months.     

Maternal Diets in India: Gaps,Barriers, and Opportunities

Suboptimal dietary intake is a critical cause of poor maternal nutrition, with several adverse consequences both for mothers and for their children. This study aimed to (1) assess maternal dietary patterns in India; (2) examine enablers and barriers in adopting recommended diets; (3) review current policy and program strategies to improve dietary intakes. We used mixed methods, including empirical analysis, compiling data from available national and subnational surveys, and reviewing literature, policy, and program strategies. Diets among pregnant women are characterized by low energy, macronutrient imbalance, and inadequate micronutrient intake. Supply- and demand-side constraints to healthy diets include food unavailability, poor economic situation, low exposure to nutrition counselling, food restrictions and taboos, adverse family influence and gender norms, and gaps in knowledge. Intervention strategies with potential to improve maternal diets include food-based programs, behavior change communication, and nutrition-sensitive agriculture interventions. However, strategies face implementation bottlenecks and limited effectiveness in real-world at-scale impact evaluations. In conclusion, investments in systems approaches spanning health, nutrition, and agriculture sectors, with evaluation frameworks at subnational levels, are needed to promote healthy diets for women.     

Attitudes toward HPV vaccination among parents of adolescent girls in Mysore,India

This study investigates attitudes toward human papillomavirus (HPV) vaccination among parents of adolescent girls in Mysore, India. Seven focus group discussions were held among parents of adolescent girls stratified by sex, religion and region to explore attitudes about cervical cancer and HPV vaccination. The study found that while parents have limited knowledge about HPV or cervical cancer, most are still highly accepting an HPV vaccine. In addition, high acceptability levels appear to reflect positive attitudes toward the government universal immunization program in general, rather than to the HPV vaccine in particular. The results highlight the need for additional education and health promotion regarding HPV and cervical cancer prevention in India.     

Maternal reproductive and demographic characteristics as risk factors for hypospadias

This study examined the association of hypospadias risk with several maternal reproductive and demographic characteristics: age, parity, body mass index (BMI), nausea and vomiting of pregnancy (NVP), multiple pregnancy, fertility treatments and procedures, education and race-ethnicity. The study included data on deliveries with estimated due dates from October 1997 to December 2000 that were part of the National Birth Defects Prevention Study, a multi-state case-control study of many birth defects. The analysis included 502 cases with second or third degree hypospadias (i.e. the urethra opened at the penile shaft, scrotum or perineum) and 1286 male, liveborn, non-malformed controls. Risks were estimated from a multivariable logistic regression model that included all exposures of interest. Results indicated particularly elevated risks among births to women who were primiparae, aged >or=35 years and had a BMI of >26, compared with women who were multiparae, aged <30 years and had a BMI of 相似文献   

2017年兰州市孕产妇母婴健康素养状况及影响因素

目的:了解兰州市孕产妇母婴健康素养状况,为开展妇幼健康教育工作提供依据。方法:采用问卷调查的方法,对1661名孕产妇进行调查,采用多因素logistic回归分析孕产妇母婴健康素养水平的影响因素。结果:兰州市孕产妇母婴健康素养水平为16.0%(95%CI:14.2%~17.8%)。多因素logistic回归分析结果显示:农村地区、低年龄、低文化程度和人口流动是孕产妇具备母婴健康素养的阻碍因素。结论:兰州市孕产妇母婴健康素养水平较低,应提高健康教育的针对性和有效性,促进孕产妇母婴健康素养水平的提升。     

Predictors of HIV risk among men seeking treatment for substance abuse in India

The purpose of this study was to investigate the prevalence and correlates of HIV risk among men receiving treatment for substance abuse in India. Consecutive inpatients from the major substance abuse hospital in southern India were screened using a structured interview and standardized measures to obtain demographic, psychiatric, sexual behavior, and substance use data at the time of admission. Seventy-seven percent of the 352 men who were screened reported that they were sexually active during the past year, and 13% reported that they had engaged in sexual practices associated with greater risk. The most common risk practices in the past year included having multiple sexual partners (7%), paying for sex (5%), and having unprotected anal sex (4%). Engaging in risky sexual practices was associated with the presence of a co-occurring psychiatric disorder and higher scores on a drug abuse screening measure. Assessing HIV risk in substance abuse settings can help to identify patients who may benefit from HIV-risk reduction programs.     

Knowledge and information on psychological, physiological and gynaecological problems among adolescent schoolgirls of eastern India

Background

Sex education aims to reduce the risks of potentially negative outcome from sexual behavior such as fear and stigma of menstruation, unwanted and unplanned pregnancies and sexually transmitted infections including HIV. Hence, this study was conducted to determine sex education knowledge level of school going adolescents in semi urban area of Midnapore, West Bengal, India.

Methods

A cross-sectional study was conducted in two selected premier secondary school of girls in the Midnapore Town from September - October 2007. A total of 521 adolescent aged 10–19 years were selected randomly from two secondary schools of girls. However, schools were selected purposively. All information was collected by using open-ended pre-tested questionnaire.

Results

Of the total subjects 94.2% of them were in the age of 13–16 years. Nearly, 94% respondents reported their age at menarche and maximum i.e. 54% respondents experienced in the age of 11 – 13 years. It was observed that 18%, 60.7% and 21.3% of the respondents had good knowledge, moderate or some knowledge and very poor knowledge of puberty, pubertal problems and their prevention. Thirty three percent said that they had faced one or some other kind of physical problems and out of them 60% indicated that they had visited to a doctor for their problems. The suffering of any gynecological problems had 2.48 (95% CI: 1.42 – 4.36) and 1.94 (95% CI: 1.01 – 3.73) times greater among subjects with little or some knowledge and minimum or no knowledge compare to subjects with good knowledge of sex education.

Conclusion

Thus, the results show that not only knowledge regarding sex education was poor among the subjects but also their knowledge regarding sexual infections including AIDS was not satisfactory. School based sex education programs are particularly good at providing information, skills development and attitude clarification in more formal way through lesson within the curriculum. Therefore, appropriate sex education program should be initiated from the adolescence to prevent health hazards.     

Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls

It is not clear which specific cognitive function is strongest related to falls. To investigate this, not only "general cognitive functioning," but also "nonverbal and abstract reasoning," "information processing speed," and "immediate memory" were related to falls. Furthermore, relevant effect modifiers, confounders, and mediators were identified. This study was performed within the Longitudinal Aging Study Amsterdam (LASA), a multidisciplinary, prospective cohort study. In this study (n = 1437), an interaction between "immediate memory" and age was found. In persons aged 75 years and over, "immediate memory," as measured by the 15 Words Test, showed to be an independent risk factor for falls. Part of this relationship was explained by the mediating effects of activity, mobility, and grip strength. The association between the other cognitive functions and falls was only statistically significant in univariate analysis. We conclude that "immediate memory" is an independent risk factor for recurrent falls in persons aged 75 years and older.     

Gender as an independent risk factor for herpes zoster: a population-based prospective study

PURPOSE: Several studies reported a difference in herpes zoster (HZ) incidence between males and females, but limitations in design and analysis impeded the assessment of gender as an independent risk factor for HZ. This study examines the independent etiologic association between gender and HZ. METHODS: A total of 335,714 persons were observed prospectively during 2001. We registered gender and HZ occurrence, as well as other risk factors for HZ. We calculated overall crude and adjusted odds ratios (ORs) and stratified to age. RESULTS: The HZ incidence in females was 3.9/1000 patients/year (95% confidence interval [CI], 3.6-4.2), and in males, 2.5/1000 patients/year (95% CI, 2.3-2.8), with a crude OR of 1.53 (95% CI, 1.36-1.74). After adjustment for potential confounders, the adjusted OR was 1.38 (95% CI, 1.22-1.56). The incidence was greater in females in the middle-aged (age, 25 to 64 years; OR range, 1.36 to 1.83) and youngest group (OR, 1.31; 95% CI, 0.90-1.89). Gender effect was inverse in young adults (age, 15 to 24 years; OR, 0.64; 95% CI, 0.41-1.03). CONCLUSION: Female gender is an independent risk factor for HZ in the 25- to 64-year-old age groups.     

Assessment of Nutritional Risk in Community-Dwelling Older Adults (65 to 75 Years) in Kolkata,India

This study was conducted to profile nutritional risk factors in a population of community-dwelling older adults in Kolkata, India. We applied the short version of the Mini Nutritional Assessment–Short Form (MNA-SF) questionnaire among 500 participants (65 to 75 years)—263 males and 237 females. The prevalence of undernutrition was 8.8% in females and 4.9% in males; a risk of undernutrition was found in 24.5% females and 17.5% males. All those with undernutrition or at-risk were studied further using the full version of the MNA. Data regarding education, occupation, socioeconomic status, and food intake pattern were also collected. Females had a significantly lower (P < 0.01) education level than males; 73.4% males were financially independent, whereas 72.7% females were financially dependent on others. Moderate appetite loss was commonly found (64.9%), and in 24.3% of the participants appetite loss was severe. Digestive and chewing problems were present in 32.4% and 21.6% of study participants, respectively. The rate of psychological stress and/or acute disease 3 months prior to study was 47%, and 62.2% of the study population were taking 3 or more medicines per day. Weight loss of greater than 3 kg and of 1 to 3 kg during past 3 months of the study period was observed in 27% and 32.5% of the population, respectively. Undernourished individuals were also found to consume fewer protein-rich foods. We hypothesize that low education levels and lack of financial independence were the strongest underlying causes of high undernutrition in this population, particularly, among females.     

Parental age as a risk factor for isolated congenital malformations in a Polish population

Currently available data on the relationship between the prevalence of isolated congenital malformations and parental age are inconsistent and frequently divergent. We utilised the data from the Polish Registry of Congenital Malformations (PRCM) to accurately assess the interplay between maternal and paternal age in the risk of isolated non-syndromic congenital malformations.
Out of 902 452 livebirths we studied 8683 children aged 0–2 years registered in the PRCM. Logistic regression was used to simultaneously adjust the risk estimates for maternal and paternal age. Our data indicated that paternal and maternal age were independently associated with several congenital malformations. Based on our data, young maternal and paternal ages were independently associated with gastroschisis. In addition, young maternal age, but not young paternal age, carried a higher risk of neural tube defects. Advanced maternal and paternal ages were both independently associated with congenital heart defects. Moreover, there was a positive association between advanced paternal age and hypospadias, cleft palate, and cleft lip (with or without cleft palate).
No significant relationships between parental age and the following congenital malformations were detected: microcephaly, hydrocephaly, oesophageal atresia, atresia or stenosis of small and/or large intestine, ano-rectal atresia or stenosis, renal agenesis or hypoplasia, cystic kidney disease, congenital hydronephrosis, diaphragmatic hernia and omphalocele.     

Serum triglycerides as an independent risk factor for death from coronary heart disease in middle-aged Norwegian men

The relation between nonfasting serum triglycerides and death from coronary heart disease was studied in 37,546 men aged 35-49 years who were examined during 1972-1977 in four counties in Norway. During an average follow-up period of nine years, 369 deaths from coronary heart disease occurred. In univariate analysis, log(triglycerides) were a weak, but statistically significant predictor of coronary death in the age groups 40-44 and 45-49 years. Within-area analysis showed that a high triglyceride area represented no extreme. When other coronary risk factors were adjusted for, log(triglycerides) remained a significant independent predictor at ages 45-49 years and at higher levels of serum cholesterol. The predictive strength of serum cholesterol was largely the same whether log(triglycerides) were taken into account or not, whereas the predictive strength of log(triglycerides) depended on whether serum cholesterol was accounted for. The strength of coronary death prediction of the logarithm of serum triglycerides was hardly greater than might be explained by the fact that triglycerides are an indicator of the usual cholesterol level of the subject.     

Elevated admission serum calcium phosphate product as an independent risk factor for acute kidney injury in hospitalized patients

Background: Increased serum calcium-phosphate product (CaP) can result in acute kidney injury (AKI) due to tubular and interstitial calcium phosphate deposits. CaP of > 55 mg²/dL² is also associated with systemic calcification. However, the risk of AKI development among hospitalized patients with different admission calcium-phosphate product levels remains unclear.

Methods: All adult hospitalized patients who had both admission serum calcium and phosphate levels available from 2009 through 2013 were enrolled. Admission CaP was categorized based on its distribution into six groups (<22, 22- < 27, 27- < 32, 32- < 37, 37- < 42 and ≥42 mg²/dL²). The odds ratio (OR) of in-hospital mortality by admission CaP, using the CaP category of < 22 mg²/dL² as the reference group, was obtained by logistic regression analysis.

Results: After excluding patients with end-stage renal disease, without serum creatinine measurement, and those who presented with AKI at the time of admission, a total of 9,864 patients were studied. In-hospital AKI occurred in 1,478 patients (15.0%). The incidence of AKI among patients with admission CaP < 22, 22 to < 27, 27 to < 32, 32 to < 37, 37 to < 42, and ≥42 mg²/dL² was 11.1%, 12.4%, 14.9%, 15.2%, 17.5%, and 19.9%, respectively. After adjusting for potential confounders, a CaP ≥37 mg²/dL² was associated with an increased risk of developing AKI with OR of 1.53 (CI 1.19–1.96) and 1.63 (CI 1.25–2.14) in patients with admission CaP 37- < 42 and ≥42, respectively. Subgroup analysis based on eGFR consistently demonstrated that CaP ≥37 mg²/dL² was associated with an increased risk of developing AKI in both chronic kidney disease (CKD) and non-CKD patients.

Conclusion: Elevated admission CaP was independently associated with an increased risk for in-hospital AKI.