52 research outputs found
The influence of pre-pregnancy weight and weight changes on pregnancy complications and child growth and development
No full textBackground and aims: Pre-pregnancy obesity (body mass index [BMI] ≥ 30 kg/m2) and pregnancy complications such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are major and increasing global public health concerns because of a number of consequences to women and their babies. While the associations of pre-pregnancy obesity and GDM and HDP are well established, little is known about the relationship between pre-pregnancy weight change and GDM and HDP risk. Growing evidence also implicates pre-pregnancy obesity and pregnancy complications with offspring childhood growth and development, although the findings are inconclusive, and associations of preconception BMI trajectory and child outcomes have been rarely investigated. This thesis examines the associations between pre-pregnancy weight characteristics, GDM and HDP and offspring childhood growth and development.
Methods: Several data sources and analysis approaches were employed across the papers included in the thesis. First, literature searches were performed in CINAHL, EMBASE, PSYCINFO, PUBMED and SCOPUS for systematic reviews on 1) the association of pre-pregnancy obesity and offspring childhood physical and cognitive development, and 2) the association of diabetes during pregnancy and childhood cognitive development. Second, self-reported data from the 1973-78 cohort (aged 18-23 years at the first survey in 1996) of the Australian Longitudinal Study on Women’s Health (ALSWH) were used to examine the associations between adult pre-pregnancy weight change and GDM (n = 5,242) and HDP (n = 4,813) risk. Third, data from the 1973-78 cohort of the ALSWH, Mothers and their Children’s Health (MatCH) study and linked data from the Australian Early Development Census (AEDC) were used to evaluate the associations of 1) preconception BMI trajectories, GDM and HDP and offspring childhood physical and cognitive development (n = 771), and 2) preconception BMI trajectories and offspring childhood BMI (n = 2,733), and 3) to quantify the mediation role of offspring’s birthweight between the association of pre-pregnancy BMI and childhood anthropometrics (BMI-for-age, height-for-age, weight-for-age and weight-for-height) (n = 1,618). In addition to descriptive statistics, multinomial logistic regression, generalised estimating equations, g-computation and latent class growth modelling were used for analyses.
Results: A total of 17 articles were eligible for the systematic review on pre-pregnancy obesity and offspring childhood physical and cognitive development. A large proportion of studies supported the adverse association between pre-pregnancy obesity and childhood cognitive development. A few studies also demonstrated a negative association between pre-pregnancy obesity and the gross motor function of the offspring but not with the fine motor function. The evidence was based on a limited number of studies with heterogeneous measurement scales and obesity definition.
For the systematic review on diabetes during pregnancy and offspring childhood cognitive development, we found a small number of geographically limited studies, the majority of which were small and did not adjust for key confounders. Of 14 eligible studies included in the systematic review, 10 investigated the associations between pre-existing diabetes or both pre-existing diabetes and GDM and cognitive development in offspring. Of these, six found at least one negative association. Four studies exclusively examined the relationships between GDM and offspring’s cognitive development; two of them found negative, one positive and one null associations.
In the ALSWH, annual pre-pregnancy weight change from early adulthood (mean age 20 years, 1996) to the index pregnancy (between 2003 and 2012) was significantly associated with risk of development of GDM and HDP. Women with considerable weight gain (>2.5% body weight /year) were more likely to develop GDM (RR = 2.94, 95% CI: 2.16, 4.01) and HDP (RR = 2.31, 95% CI: 1.77, 3.03) compared to women with stable weight (loss or gain of up to 1.5%). We also found that children (mean age 5 years) born to women with a chronically obese BMI trajectory were more likely to be classified as developmentally vulnerable/at-risk on the AEDC domains of gross and fine motor skills (RR = 1.64, 95% CI: 1.04, 2.61) and communication skills and general knowledge (RR = 1.71, 95% CI: 1.09, 2.68) compared with children born to women with a normative BMI trajectory. They also had an elevated risk of suspected gross motor delay (RR = 2.62, 95% CI: 1.26, 5.44) at the average age of 3.5 years, and being overweight (RR = 2.48, 95% CI: 1.65, 3.73) and obese (RR = 6.65, 95% CI: 3.40, 13.01) at the average age of 7.7 years. Diabetes or hypertensive disorders during pregnancy were not associated with child outcomes. Our mediation analysis further demonstrated that pre-pregnancy obesity had only significant natural direct (β = 0.75, 95% CI: 0.55, 0.95) and total causal effects (β = 0.79, 95% CI: 0.59, 0.99) on children’s BMI at the average age of 8.6 years.
Conclusions: Although there are relatively few data available, the current evidence from the literature suggests that pre-pregnancy obesity and diabetes in pregnancy are associated with offspring’s childhood cognitive development, but evidence of the association between pre-pregnancy obesity and physical development of children is too scarce to offer a conclusion. Evidence from our population-based prospective cohort study demonstrated that women with considerable annual pre-pregnancy weight gain were significantly more likely to develop GDM and HDP. Our study further demonstrated that children born to chronically overweight and chronically obese women were significantly more likely to be overweight and obese themselves and to have poorer physical and cognitive development. Most of the effect of pre-pregnancy obesity on child anthropometrics appears to be via a direct effect, not mediated through offspring’s birthweight. Further studies are warranted to unravel the mechanisms linking preconception BMI trajectory and child outcomes and to examine the impact of preconception weight loss intervention to improve offspring childhood outcomes
Maternal preconception weight trajectories are associated with offsprings’ childhood obesity
No full textImpact of multidrug-resistant tuberculosis and its medications on adverse maternal and perinatal outcomes: protocol for a systematic review and meta-analysis
No full textIntroduction Multidrug-resistant tuberculosis (MDR-TB) is a common public health problem affecting pregnant women. However, the impact of MDR-TB and its medication on pregnancy and perinatal outcomes has been poorly understood and inconsistently reported. Therefore, using the available literature, we aim to determine whether MDR-TB and its medications during pregnancy impact maternal and perinatal outcomes.Methods and analysis This systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches will be conducted in PubMed, Scopus and Web of Science on 10 February 2020 for studies that reported adverse maternal and perinatal outcomes due to MDR-TB and/or its medication. The search will be performed without language and time restrictions. Adverse birth outcomes include miscarriage or abortion, stillbirth, preterm birth, low birth weight, small and large for gestational age, and neonatal death. Two independent reviewers will screen search records, extract data and assess the quality of the studies. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the methodological quality of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I2 statistics will be used to assess the heterogeneity between studies.Ethics and dissemination As it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences
Prevalence and associated factors of hypertension among adults in Durame Town, Southern Ethiopia.
No full textBackgroundTo date, non-communicable diseases, such as cardiovascular diseases, are becoming severe public health challenges particularly in developing countries. Hypertension is a modifiable risk factor that contributes the leading role for mortality. The problem is significant in low- and middle-income countries like sub-Saharan Africa. However, there are limited studies in developing countries, particularly in Ethiopia. Hence, determining the magnitude of hypertension and identifying risk groups are important.MethodsA community based cross sectional study was conducted in April 2013 among adults (age>31 years) old. A systematic sampling technique was used to select a total of 518 study participants. Data were collected after full verbal informed consent was obtained from each participant. Multivariable logistic regressions were fitted to control the effect of confounding. Adjusted Odds ratios (OR) with their 95% confidence intervals (95% CI) were calculated to measure associations. Variables having P-value ResultsThe overall prevalence of hypertension in Durame town was 22.4% (95% CI: 18.8-26.0). Nearly 40% of hypertensive patients were newly screened. Male sex [AOR = 2.03, 95% CI; 1.05-3.93], age [AOR = 29.49, 95% CI; 10.60-81.27], salt use [AOR = 6.55, 95% CI; 2.31-18.53], eating vegetable three or fewer days per week [AOR = 2.3,95% CI; 1.17-4.51], not continuously walking at least for 10 minutes per day [AOR = 7.82, 95% CI; 2.37-25.82], having family history of hypertension [AOR = 2.46, 95%CI; 1.31-4.61] and being overweight/obese [AOR = 15.7, 95% CI 7.89-31.21)] were found to be risk factors for hypertension.ConclusionsThe prevalence of hypertension is found to be high. Older age, male sex, having family history of hypertension, physical inactivity, poor vegetable diet, additional salt consumption and obesity were important risk factors associated with hypertension among adults. Community level intervention measures with a particular emphasis on prevention by introducing lifestyle modifications are recommended
Incidence and predictors of tuberculosis among HIV positive children at University of Gondar Referral Hospital, Northwest Ethiopia: a retrospective follow-up study
No full textBackground. The aim of this study was to determine the incidence of tuberculosis and its predictors among HIV positive children. Methods. A six-year retrospective follow-up study was conducted among HIV infected children aged less than 15 years. Life table was used to estimate the cumulative probability of tuberculosis free survival. Cox proportional hazards model was used to identify predictors of tuberculosis. Results. A total of 271 HIV positive children were followed for six years and produced 1100.50 person-years of observation. During the follow-up period 52 new TB cases occurred. The overall incidence density of TB was 4.9 per 100 PY. Inappropriate vaccination [AHR: 8.03 (95% CI; 4.61-13.97)], ambulatory functional status [AHR: 1.99 (95% CI; 1.04-3.81)], and having baseline anemia [AHR: 2.23 (95% CI; 1.19-4.15)] were important predictors of time to TB occurrence. Conclusion. TB incidence rate was high. Early diagnosis and treatment of anemia and strengthening immunization program would reduce the risk of TB occurrence
Authors’ reply re: Multidrug-resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta-analysis: Practice-embedded research to address knowledge gaps in multidrug-resistant tuberculosis in pregnancy
No full textAUTHOR'S REPL
Diabetes in pregnancy and childhood cognitive development: a systematic review
No full textCONTEXT: The effect of diabetes during pregnancy on the cognitive development of offspring is unclear because of inconsistent findings from limited studies. OBJECTIVE: This review was aimed to provide the best available scientific evidence on the associations between maternal pregnancy diabetes and the cognitive development of offspring. DATA SOURCES: A search was conducted in the Embase, CINAHL, PubMed, PsycINFO, and Scopus databases. STUDY SELECTION: Studies addressing the cognitive development of offspring (aged ?12 years) as outcome and any diabetes in pregnancy as an exposure were included. DATA EXTRACTION: Data were extracted and evaluated for quality by 2 independent reviewers. RESULTS: Fourteen articles were eligible for the review. Ten studies investigated the associations between maternal pregestational diabetes or both pregestational and gestational diabetes and offspring's cognitive development; 6 studies found at least 1 negative association. Four studies exclusively examined the relationships between gestational diabetes and offspring's cognitive development; 2 studies found a negative association, 1 a positive association, and 1 a null association. The use of diverse cognitive and diabetes assessment tools/criteria, as well as statistical power, contributed to the inconsistent findings. LIMITATIONS: The English-language restriction and publication bias in the included studies are potential limitations. CONCLUSIONS: Although there are few data available regarding the associations between maternal pregnancy diabetes and offspring's cognitive development, this review found that maternal diabetes during pregnancy seems to be negatively associated with offspring's cognitive development. Large prospective studies that address potential confounders are needed to confirm the independent effect of maternal diabetes during pregnancy
Food Insecurity in Farta District, Northwest Ethiopia: a community based cross–sectional study
No full textBackground
Access to sufficient food is essential for household welfare as well as for accomplishing other development activities. Households with insufficient access to food often face other challenges related to food insecurity including poor health and a decline in productivity. These challenges can often create a vicious circle whereby households are unable to produce enough food even during a good crop season. Thus, this study aimed to determine the magnitude of food insecurity and its determinants in rural households of Farta District, Northwest Ethiopia.
Methods
A community based cross-sectional study was conducted from September to October 2012. Household heads were recruited using a multistage random sampling technique. Data were collected by face-to-face interviews using the Household Food Insecurity Access Scale (HFIAS) tool after verbal informed consent. Data were entered to Epi info 2002 and exported to SPSS version 16 for analysis. Multiple logistic regressions were fitted and odds ratios with 95% confidence intervals were calculated to identify associated factors and control confounding effect.
Results
A total of 836 households were included in this study. Nearly three quarters of the households (70.7%) had food insecurity. Households headed by females (AOR = 3.18, 95% CI:1.08, 15.21), lack of education (AOR = 2.59, 95% CI: 1.46, 4.60), family size of 4-7 (AOR = 2.39, 95% CI: 1.21,4.70), family size of >7 (AOR = 13.23,95% CI:6.18, 28.32), few or absence of livestock (AOR = 5.60, 95% CI:1.28, 24.43), absence of income from off-farm activities (AOR = 3.12, 95% CI:1.53, 6.36), lack of irrigation (AOR = 3.54, 95% CI:2.14, 5.18) and lack of perennial income (AOR = 3.15, 95% CI:1.88, 5.27) were factors associated with food insecurity.
Conclusions
This study revealed that most households of the district were food insecure. Hence, the promotion of contraceptive use, off-farm employment activities and the development of small scale irrigation are important recommendations to reduce food insecurity
Adverse birth outcomes among deliveries at Gondar University Hospital, Northwest Ethiopia
No full textAdverse birth outcomes are major public health problems in developing countries. Data, though scarce in developing countries including Ethiopia, on adverse birth outcomes and the risk factors are important for planning maternal and child health care services. Hence, this study aimed to determine the prevalence and associated factors of adverse birth outcomes among deliveries at Gondar University Hospital, Northwest Ethiopia.Institution based cross-sectional study was conducted in February 2013 at Gondar University Hospital. Data were collected by face-to-face interview of 490 women after verbal informed consent using a pretested and structured questionnaire. Gestational age was determined based on the last normal menstrual period. Birth weight was measured following standards. Multiple logistic regressions were fitted and odds ratios with their 95% confidence interval were computed to identify associated factors.The mean age of women was 26.2 (±5.2 SD) years. HIV infection among laboring women was 4.8%. About 23% of women had adverse birth outcomes (14.3% preterm, 11.2% low birth weight and 7.1% still births). Women having history of either preterm delivery or small baby (AOR: 3.1, 95% CI 1.1- 8.4) were more likely to have preterm births. Similarly, history of delivering preterm or small baby (AOR: 8.4, 95% CI 2.4- 29.4), preterm birth (AOR: 5.5, 95% CI 2.6- 11.6) and hypertension (AOR: 5.8, 95% CI 1.8- 19.6) were associated factors with low birth weight. Ante partum haemorrhage (AOR: 8.43, 95% CI 1.28- 55.34), hypertension (AOR: 9.5, 95% CI 2.1-44.3), history of perinatal death (AOR: 13.9, 95% CI 3.3- 58.5) and lack of antenatal care follow up (AOR: 9.7, 95% CI 2.7 - 35.8) were significantly associated with still birth.Prevalence of adverse birth outcomes (still birth, preterm birth and low birth weight) were high and still a major public health problem in the area. Histories of perinatal death, delivering preterm or small baby, ante partum hemorrhage, lack of ante natal care follow up and hypertension were associated factors with adverse birth outcomes. Thus, further enhancements of ante natal and maternal care and early screening for hypertension are recommended
Non-adherence to anti-tuberculosis treatment and determinant factors among patients with tuberculosis in northwest Ethiopia.
No full textBackgroundNon-adherence to anti tuberculosis treatment is one of the crucial challenges in improving tuberculosis cure-rates and reducing further healthcare costs. The poor adherence to anti-tuberculosis treatment among patients with tuberculosis is a major problem in Ethiopia. Hence, this study assessed level of non-adherence to anti-tuberculosis therapy and associated factors among patients with tuberculosis in northwest Ethiopia.MethodsAn institution based cross-sectional survey was conducted among tuberculosis patients who were following anti-tuberculosis treatment in North Gondar zone from February 20--March 30, 2013. Data were collected by trained data collectors using a structured and pre-tested questionnaire. Data were entered to EPI INFO version 3.5.3 and analyzed using statistical package for social sciences (SPSS) version 20. Multiple logistic regressions were fitted to identify associations and to control potential confounding variables. Odds ratio (OR) with 95% confidence interval was calculated and p-valuesResultsA total of 280 tuberculosis patients were interviewed; 55.7% were males and nearly three quarters (72.5%) were urban dwellers. The overall non-adherence for the last one month and the last four days before the survey were 10% and 13.6% respectively. Non-adherence was high if the patients had forgetfulness (AOR 7.04, 95% CI 1.40-35.13), is on the continuation phase of chemotherapy (AOR: 6.95, 95% CI 1.81-26.73), had symptoms of tuberculosis during the interview (AOR: 4.29, 95% CI 1.53-12.03), and had co-infection with HIV (AOR: 4.06, 95% CI 1.70-9.70).ConclusionsNon-adherence to anti-tuberculosis treatment was high. Forgetfulness, being in the continuation phases of chemotherapy, having symptoms of tuberculosis during the interview, and co-infected with HIV were significantly associated with non-adherence to anti-tuberculosis therapy. Special attention on adherence counseling should be given to symptomatic patients, TB/HIV co-infected patients, and those in the continuation phase of the tuberculosis therapy
- …
