161 research outputs found
Author response to: Cardiovascular risk factors in offspring exposed to gestational diabetes mellitus in utero: systematic review and meta-analysis
No full textLetter to the EditorThis commentary is an author response to Yu and colleagues regarding the manuscript entitled ‘Cardiovascular risk factors in offspring exposed to gestational diabetes mellitus in utero: Systematic review and meta-analysis’. We address their concern regarding minor errors in our manuscript, our search strategy and assessment of heterogeneity.Maleesa M. Pathirana, Zohra S. Lassi, Claire T. Roberts, and Prabha H. Andraweer
Antibiotic therapy versus no antibiotic therapy for children aged 2 to 59 months with WHO-defined non-severe pneumonia and wheeze
No full textThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the efficacy of antibiotic therapy versus no antibiotic therapy for children aged two to 59 months with WHO‐defined non‐severe pneumonia and wheeze.Zohra S Lassi, Zulfiqar A Bhutt
Health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review of observational and qualitative studies [version 1; peer review: 2 approved]
No full textFirst published: 19 Feb 2019Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies. Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking. Results: A total of 159 observational and qualitative studies met the inclusion criteria. The review of observational and qualitative studies identified social, cultural and health services factors that contribute to delays in health care seeking, and influence decisions to seek care. Timely recognition of danger signs, availability of finances to arrange for transport and affordability of health care cost, and accessibility to a health facility were some of these factors. Conclusions: Effective dealing of factors that contribute to delays in health care seeking would lead to significant improvements in mortality, morbidity and care seeking outcomes, particularly in countries that share a major brunt of maternal and newborn morbidity and mortality. Registration: PROSPERO CRD42012003236.Zohra S. Lassi, Philippa Middleton, Zulfiqar A. Bhutta, Caroline Crowthe
Cardiovascular risk factors in offspring exposed to gestational diabetes mellitus in utero: systematic review and meta-analysis
No full textPublished online by Cambridge University Press: 06 January 2020Gestational diabetes mellitus (GDM) is a pregnancy complication that affects one in seven pregnancies. Emerging evidence demonstrates that children born of pregnancies complicated by GDM may be at increased risk of cardiovascular disease (CVD) in adulthood. Therefore, the aim of this study was to determine cardiovascular risk factors in offspring exposed to GDM in utero. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Information was extracted on established CVD risk factors including blood pressure, lipids, blood glucose, fasting insulin, body mass index (BMI), and endothelial/microvascular function. The review protocol is registered in PROSPERO (CRD42018094983). Prospective and retrospective studies comparing offspring exposed to GDM compared to controls (non-GDM pregnancies) were considered. We included studies that defined GDM based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) definition, or prior definitions. The PRISMA guidelines were followed in conducting this systematic review. Methodological quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Study selection, data extraction, and quality assessment were done by two independent reviewers. The data were pooled using a random-effects model. Of 59 eligible studies, 24 were included in the meta-analysis. Offspring exposed to GDM had higher systolic blood pressure (mean difference (MD): 1.75 mmHg, 95% CI 0.57-2.94; eight studies, 7264 participants), BMI z-score (MD 0.11, 95% CI 0.02-0.20; nine studies, 8759 participants), and glucose (standard MD 0.43, 95% CI 0.08-0.77; 11 studies, 6423 participants) than control participants. In conclusion, offspring exposed to GDM have elevated systolic blood pressure, BMI, and glucose. Those exposed to GDM in utero may benefit from early childhood blood pressure measurements.Maleesa M. Pathirana, Zohra S. Lassi, Claire T. Roberts and Prabha H. Andraweer
Obesity, prediabetes and diabetes in adolescents and women: evidence-based interventions
No full textBook Series. Published in book Health and Nutrition in Adolescents and Young Women Preparing for the Next Generation (ISBN: 9783318026719)Around the world, the prevalence of obesity and diabetes represents a grave scenario as the occurrence of obesity in adolescents has tripled and in the general population has doubled in the past 30 years. This signals a global crisis as obesity and diabetes surface as a widely rampant form of health concern for individuals worldwide that needs to be immediately addressed. Evidence has shown higher chances of adverse pregnancy outcomes in women who are overweight/obese. Simple interventions such as diet, physical activity and strict glycemic control can reduce adiposity in young girls and women. The evidence for beneficial effect of physical activity on gestational diabetes is also more convincing as it reduces the risk by 53%. Physical activity and diet for maintaining normal weight in women have been shown to improve pregnancy outcomes. Similarly, dietary counseling and glycemic monitoring in women with prediabetes and diabetes are also beneficial. Given that weight is a modifiable risk factor, public health campaigns should direct their focus on young and adolescent girls to make them aware of the importance of healthy eating, physical activity and maintaining normal weight for their own well-being as well as for the problems they could face during pregnancy.Z. A. Bhutta, M. Makrides, A. M. Prentic
Cardiovascular risk factors in offspring of preeclamptic pregnancies—systematic review and meta-analysis
No full textOBJECTIVE:To evaluate evidence for increased cardiovascular disease (CVD) risk factors in children exposed to preeclampsia in utero. STUDY DESIGN:PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and EMBASE electronic databases were searched with an end of search date of June 4, 2018. Prospective and retrospective studies that compared CVD risk factors in those exposed to preeclampsia in utero with controls were eligible. Information was extracted on established CVD risk factors, including blood pressure, lipid profile, blood glucose, fasting insulin, body mass index, and endothelial/microvascular function. RESULTS:Thirty-six studies provided cumulated data on 53 029 individuals. In utero exposure to preeclampsia was associated with 5.17 mm Hg (95% CI 1.60-8.73) greater mean systolic, 4.06 mm Hg (95% CI 0.67-7.44) greater mean diastolic blood pressure, and 0.36 kg/m2 (95% CI 0.04-0.68) greater mean body mass index during childhood or young adulthood. No significant association was seen between exposure to preeclampsia in utero and other CVD risk factors. CONCLUSIONS:Offspring of preeclamptic pregnancies demonstrate risk factors for CVD during childhood and young adult life. Early blood pressure screening of children born after preeclamptic pregnancies may identify those that require interventions or preventive strategies to reduce later life CVD risk.Prabha H. Andraweera, Zohra S. Lass
Community-based antibiotic delivery for possible serious bacterial infections in neonates in low-and middle-income countries
No full textBackground: The recommended management for neonates with a possible serious bacterial infection (PSBI) is hospitalisation and treatment with intravenous antibiotics, such as ampicillin plus gentamicin. However, hospitalisation is often not feasible for neonates in low- and middle-income countries (LMICs). Therefore, alternative options for the management of neonatal PSBI in LMICs needs to be evaluated. Objectives: To assess the effects of community-based antibiotics for neonatal PSBI in LMICs on neonatal mortality and to assess whether the effects of community-based antibiotics for neonatal PSBI differ according to the antibiotic regimen administered. Search Methods: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 3), MEDLINE via PubMed (1966 to 16 April 2018), Embase (1980 to 16 April 2018), and CINAHL (1982 to 16 April 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Selection Criteria: We included randomised, quasi-randomised and cluster-randomised trials. For the first comparison, we included trials that compared antibiotics which were initiated and completed in the community to the standard hospital referral for neonatal PSBI in LMICs. For the second comparison, we included trials that compared simplified antibiotic regimens which relied more on oral antibiotics than intravenous antibiotics to the standard regimen of seven to 10 days of injectable penicillin/ampicillin with an injectable aminoglycoside delivered in the community to treat neonatal PSBI. Data Collection and Analysis: We extracted data using the standard methods of the Cochrane Neonatal Group. The primary outcomes were all-cause neonatal mortality and sepsis-specific neonatal mortality. We used the GRADE approach to assess the quality of evidence. Main Results: For the first comparison, five studies met the inclusion criteria. Community-based antibiotic delivery for neonatal PSBI reduced neonatal mortality when compared to hospital referral only (typical risk ratio (RR) 0.82, 95% confidence interval (CI) 0.68 to 0.99; 5 studies, n = 125,134; low-quality evidence). There was, however, a high level of statistical heterogeneity (I² = 87%) likely, due to the heterogenous nature of the study settings as well as the fact that four of the studies provided various co-interventions in conjunction with community-based antibiotics. Community-based antibiotic delivery for neonatal PSBI showed a possible effect on reducing sepsis-specific neonatal mortality (typical RR 0.78, 95% CI 0.60 to 1.00; 2 studies, n = 40,233; low-quality evidence).For the second comparison, five studies met the inclusion criteria. Using a simplified antibiotic approach resulted in similar rates of neonatal mortality when compared to the standard regimen of seven days of injectable procaine benzylpenicillin and injectable procaine benzylpenicillin and injectable gentamicin delivered in community-settings for neonatal PSBI (typical RR 0.81, 95% CI 0.44 to 1.50; 3 studies, n = 3476; moderate-quality evidence). In subgroup analysis, the simplified antibiotic regimen of seven days of oral amoxicillin and injectable gentamicin showed no difference in neonatal mortality (typical RR 0.84, 95% CI 0.47 to 1.51; 3 studies, n = 2001; moderate-quality evidence). Two days of injectable benzylpenicillin and injectable gentamicin followed by five days of oral amoxicillin showed no difference in neonatal mortality (typical RR 0.88, 95% CI 0.29 to 2.65; 3 studies, n = 2036; low-quality evidence). Two days of injectable gentamicin and oral amoxicillin followed by five days of oral amoxicillin showed no difference in neonatal mortality (RR 0.67, 95% CI 0.24 to 1.85; 1 study, n = 893; moderate-quality evidence). For fast breathing alone, seven days of oral amoxicillin resulted in no difference in neonatal mortality (RR 0.99, 95% CI 0.20 to 4.91; 1 study, n = 1406; low-quality evidence). None of the studies in the second comparison reported the effect of a simplified antibiotic regimen on sepsis-specific neonatal mortality. Authors’ Conclusions: Low-quality data demonstrated that community-based antibiotics reduced neonatal mortality when compared to the standard hospital referral for neonatal PSBI in resource-limited settings. The use of co-interventions, however, prevent disentanglement of the contribution from community-based antibiotics. Moderate-quality evidence showed that simplified, community-based treatment of PSBI using regimens which rely on the combination of oral and injectable antibiotics did not result in increased neonatal mortality when compared to the standard treatment of using only injectable antibiotics. Overall, the evidence suggests that simplified, community-based antibiotics may be efficacious to treat neonatal PSBI when hospitalisation is not feasible. However, implementation research is recommended to study the effectiveness and scale-up of simplified, community-based antibiotics in resource-limited settings.Jessica Duby, Zohra S Lassi, Zulfiqar A Bhutt
Effect of perinatal consumption of low-calorie sweetener on maternal health: a systematic review and meta-analysis
No full textBackground and aims: Evidence regarding perinatal low-calorie (or artificial) sweetener (LCS) consumption and its effect on maternal health outcomes is limited and inconclusive. The primary outcomes of our systematic review and meta-analysis were the effect of preconception and pregnancy LCS exposure on reproductive and pregnancy outcomes. Secondary outcomes included long-term maternal health. Methods: A systematic search of electronic databases, including PubMed, Embase, CINAHL, the Cochrane Library, Scopus, Web of Science, PsycINFO, ProQuest Health and Medical, ClinicalTrials.gov and Google Scholar, was conducted up to 20 November 2023. Primary studies, including clinical trials, cohort studies, caseecontrol studies, which reported any LCS consumption during perinatal period and pregnancy and maternal health outcomes were eligible. A random effects model with restricted maximum likelihood estimation was used for the meta-analysis. We appraised the quality of the included studies using the National Institute of Health study quality appraisal tool and the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation tool. Results: A total of 19 eligible studies with 203,706 participants were included. LCS consumption during pregnancy was associated with 11% increased risk of preterm birth (RR ¼ 1.11, 95% CI: 1.07e1.16, I 2 ¼ 0.01%) and 42% increased risk of gestational diabetes (RR ¼ 1.42, 95% CI: 0.98e2.04, I2 ¼ 67.60%) compared with no consumption, however, the effect size for gestational diabetes was not precise as the 95% CI indicated that the effect estimate could range from 2% lower risk to 204% (or 2.04 times) higher risk. We found no association between LCS consumption during pregnancy and gestational weight gain (standardized mean difference (SMD) ¼ 0.04; 95% CI: 0.17 - 0.24, I2 ¼ 41.31%) or gestational age at birth (SMD ¼ 0.00; 95% CI: 0.13 e 0.14, I2 ¼ 80.13%). The effect of LCS consumption on reproductive treatment outcomes were inconsistent. Conclusions: Based on the evidence available, LCS consumption in pregnancy was associated with increased risk of preterm birth and gestational diabetes. Robust research, such as well-designed randomized trials and large prospective cohort studies, is required to confirm the causal effect of LCS consumption during perinatal period on adverse maternal health outcomes.Bereket Gebremichael, Zohra S. Lassi, Mumtaz Begum, Shao Jia Zho
Association between low‐calorie sweetener consumption during pregnancy and child health: A systematic review and meta‐analysis
No full textFirst published: 30 September 2024We examined the association between low‐calorie sweeteners (LCS) consumption during preconception, pregnancy, and breastfeeding and child health outcomes. A systematic search of electronic databases in PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature, the Cochrane Library, Scopus, Web of Science, PsycINFO, ProQuest Health and Medical, ClinicalTrials.gov, and Google Scholar was conducted up to 21 September 2023. A random effects model with restricted maximum likelihood estimation was used for the meta‐analysis. Seventeen eligible studies were included. The standardised mean difference (SMD) and 95% confidence interval (CI) in birth weight between those who frequently consumed LCS (≥1 serve/day) during pregnancy and those who did not consume LCS was 0.04 (0.00, 0.08) (four cohort studies). Any LCS consumption during pregnancy compared with no consumption was not associated with birth weight [SMD (95% CI) = 0.03 (−0.03, 0.08)] (four cohort studies). Any LCS consumption during pregnancy was not associated with body mass index z‐scores. The weighted mean difference (95% CI) was 0.00 (−0.05, 0.06) at birth, 0.06 (−0.29, 0.40) at 6 months, −0.04 (−0.19, 0.10) at 1 year, 0.00 (−0.16, 0.17) at 3 years, and 0.10 (−0.15, 0.34) at 7 years of the child age, compared with no intake (five cohort studies). The odds of being overweight at 1 year among children exposed to LCS during pregnancy was 1.19 (OR [95% CI]: 1.19 [0.81, 1.58]) compared with unexposed children (two cohort studies). The effect sizes were not precise for all the outcomes as the 95% CI indicated the effect estimates could range from small protective to a higher risk. The effect of LCS consumption on child behaviour and cognition was inconsistent. There is not enough evidence to confirm LCS consumption during pregnancy affects birth weight and risk of overweight in children. However, frequent consumption increased birth weight and the risk of overweight at different ages, though the effects were imprecise. More robust research evidence is required as the quality of evidence is low.Bereket Gebremichael, Zohra S. Lassi, Mumtaz Begum, Shao Jia Zho
Women's Participation in Household Decision Making and Justification of Wife Beating: A Secondary Data Analysis from Pakistan’s Demographic and Health Survey
No full textIntroduction: Globally, women's empowerment is one of the important factors impacting the development of the nation. However, several women in developing countries, including Pakistan, experience a high level of gender discrimination and inequity. In this study, data from the Demographic and Health Survey (DHS) were used to measure empowerment and its predictors among women in Pakistan. Methods: Pakistan's 2017-2018 DHS dataset was used to measure women's empowerment using two indicators, i.e., participation in decision making and views on wife beating among 4216 married women. The determinants of empowerment, such as age, place of residence, regions, wealth index, education, partner's education, partner's occupation, number of children, consanguinity, the age difference between husband and wife, house and land ownership, and house inheritance, are reported as prevalence ratios (PRs) with a 95% confidence intervals (CI). Multivariate regression models were used to produce covariate-adjusted PRs and 95% CIs. Results: More than half of all women were empowered (52.5%). Upon multivariate analysis, we identified that women from the province of Punjab (adjusted PR (aPR), 1.44; 95% CI, 1.20-1.73), Sindh (aPR, 1.62; 95% CI, 1.35-1.96), and KPK (aPR, 1.09; 95% CI, 0.91-1.31) compared to those living in Baluchistan; from the richest quantile (aPR, 1.65; 95% CI, 1.37-1.99), followed by the richer quantile (aPR, 1.54; 95% CI, 1.28-1.84), the middle quantile (aPR, 1.52; 95% CI, 1.28-1.81), and the poorer quantile (aPR, 1.24; 95% CI, 1.04-1.47) compared to women who were from the poorest quantile; who were highly educated (aPR, 1.45; 95% CI, 1.25-1.67), followed by those who had a secondary education (aPR, 1.32; 95% CI, 1.16-1.50) and a primary education (aPR, 1.17; 95% CI, 1.02-1.35) compared to women who were not educated; and had exposure to mass media (aPR, 1.20; 95% CI, 1.06-1.36) compared to those who had no exposure were more empowered. Conclusion: To conclude, women's empowerment in Pakistan is affected by various socioeconomic factors, as well as exposure to mass media. Targeted strategies are needed to improve access to education, employment, and poverty alleviation among women, particularly those living in rural areas. Various mass media advertisements should be practiced, targeting community norms and supporting women's empowerment.Zohra S. Lassi, Anna Ali and Salima Mehera
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