Objective
Limited data are available from low‐ and middle‐income countries (LMICs) on the relationship of haemoglobin levels to adverse outcomes at different times during pregnancy. We evaluated the ...association of haemoglobin levels in nulliparous women at two times in pregnancy with pregnancy outcomes.
Design
ASPIRIN Trial data were used to study the association between haemoglobin levels measured at 6+0–13+6 weeks and 26+0–30+0 weeks of gestation with fetal and neonatal outcomes.
Setting
Obstetric care facilities in Pakistan, India, Kenya, Zambia, The Democratic Republic of the Congo and Guatemala.
Population
A total of 11 976 pregnant women.
Methods
Generalised linear models were used to obtain adjusted relative risks and 95% CI for adverse outcomes.
Main outcome measures
Preterm birth, stillbirth, neonatal death, small for gestational age (SGA) and birthweight <2500 g.
Results
The mean haemoglobin levels at 6+0–13+6 weeks and at 26–30 weeks of gestation were 116 g/l (SD 17) and 107 g/l (SD 15), respectively. In general, pregnancy outcomes were better with increasing haemoglobin. At 6+0–13+6 weeks of gestation, stillbirth, SGA and birthweight <2500 g, were significantly associated with haemoglobin of 70–89 g/l compared with haemoglobin of 110–129 g/l The relationships of adverse pregnancy outcomes with various haemoglobin levels were more marked at 26–30 weeks of gestation.
Conclusions
Both lower and some higher haemoglobin concentrations are associated with adverse fetal and neonatal outcomes at 6+0–13+6 weeks and at 26–30 weeks of gestation, although the relationship with low haemoglobin levels appears more consistent and generally stronger.
Tweetable
Both lower and some higher haemoglobin concentrations were associated with adverse fetal and neonatal outcomes at 6–13 weeks and 26–30 weeks of gestation.
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Both lower and some higher haemoglobin concentrations were associated with adverse fetal and neonatal outcomes at 6–13 weeks and 26–30 weeks of gestation.
Objective
We sought to classify causes of stillbirth for six low‐middle‐income countries using a prospectively defined algorithm.
Design
Prospective, observational study.
Setting
Communities in ...India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya.
Population
Pregnant women residing in defined study regions.
Methods
Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer‐based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions.
Main outcome measures
Primary cause of stillbirth.
Results
Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre‐eclampsia/eclampsia. About two‐thirds (67.4%) of the stillbirths did not have signs of maceration.
Conclusions
Our algorithm determined cause of stillbirth from basic data obtained from lay‐health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre‐eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system.
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Major causes of stillbirth are asphyxia, pre‐eclampsia and haemorrhage. Infections are important in Africa.
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Major causes of stillbirth are asphyxia, pre‐eclampsia and haemorrhage. Infections are important in Africa.
Objective
To evaluate the association between maternal fructosamine levels at the time of delivery and stillbirth.
Design
Secondary analysis of a case–control study.
Setting
Multicentre study of five ...geographic catchment areas in the USA.
Population
All singleton stillbirths with known diabetes status and fructosamine measurement, and representative live birth controls.
Main outcome measures
Fructosamine levels in stillbirths and live births among groups were adjusted for potential confounding factors, including diabetes. Optimal thresholds of fructosamine to discriminate stillbirth and live birth.
Results
A total of 529 women with a stillbirth and 1499 women with a live birth were included in the analysis. Mean fructosamine levels were significantly higher in women with a stillbirth than in women with a live birth after adjustment (177 ± 3.05 versus 165 ± 2.89 μmol/L, P < 0.001). The difference in fructosamine levels between stillbirths and live births was greater among women with diabetes (194 ± 8.54 versus 162 ± 3.21 μmol/L), compared with women without diabetes (171 ± 2.50 versus 162 ± 2.56 μmol/L). The area under the curve (AUC) for fructosamine level and stillbirth was 0.634 (0.605–0.663) overall, 0.713 (0.624–0.802) with diabetes and 0.625 (0.595–0.656) with no diabetes.
Conclusions
Maternal fructosamine levels at the time of delivery were higher in women with stillbirth compared with women with live birth. Differences were substantial in women with diabetes, suggesting a potential benefit of glycaemic control in women with diabetes during pregnancy. The small differences noted in women without diabetes are not likely to justify routine screening in all cases of stillbirth.
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Maternal serum fructosamine levels are higher in women with stillbirth than in women with live birth, especially in women with diabetes.
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Maternal serum fructosamine levels are higher in women with stillbirth than in women live birth, especially in women with diabetes.
The prediction of preterm birth may be important (1) to initiate risk specific treatment; (2) to define a population that is at risk in which to study a particular treatment; or (3) to better ...understand the pathways that lead to preterm birth. Biologic fluids that have been used as sources for tests include serum, plasma, amniotic fluid, urine, vaginal and cervical secretions, saliva, and even periodontal fluid. We discuss the types of substances that are found in body fluids (eg, organisms, cytokines, enzymes, hormones) that have been studied as predictors of preterm birth, the fluids in which they are found, and issues that are related to the timing of the test, the cost, and the ease of fluid collection and processing. We emphasize that a test for any of these substances should not be introduced into clinical practice until the use of the test, which is followed by an appropriate intervention, leads to a reduction in preterm birth.
Objective
Stillbirths are among the most common adverse pregnancy outcomes, with 98% occurring in low‐income countries. More than one‐third occur in sub‐Saharan Africa (SSA). However, the medical ...conditions causing stillbirths and interventions to reduce stillbirths from these conditions are not well documented. We estimated the reductions in stillbirths possible with combinations of interventions.
Design
We developed a computerised model to estimate the impact of various interventions on stillbirths caused by the most common conditions. The model considered the location of obstetric care (home, clinic or hospital) and each intervention's efficacy, penetration and utilisation. Maternal transfers were also considered.
Setting and population
Pregnancies in SSA in 2012.
Methods
For each condition, we created a series of scenarios involving different combinations of interventions and modelled their impact on stillbirth rates.
Main outcome measures
Stillbirths associated with various maternal and fetal conditions and the percentage reduction with various interventions.
Results
Eight to ten maternal and fetal conditions were responsible for most stillbirths, but none for more than 15%. The most common conditions causing stillbirths in SSA include obstructed labour and uterine rupture, fetal distress and umbilical cord complications, fetal growth restriction, pre‐eclampsia/eclampsia, and placental abruption/placenta praevia. Syphilis and malaria contribute smaller numbers. Reducing stillbirths requires appropriate diagnosis and management of each condition, usually including hospital care for monitoring and delivery, often by caesarean section. Maternal syphilis and malaria were the only conditions for which outpatient management alone reduced stillbirth.
Conclusions
Most stillbirths in low‐income countries occur at term and during labour and therefore are preventable by appropriate obstetric care. Management focused on the maternal and fetal conditions that cause stillbirths is necessary to achieve stillbirth rates approaching those found in high‐income countries.
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Reducing stillbirth incidence requires appropriate management of each causative condition and often caesarean delivery.
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Reducing stillbirth incidence requires appropriate management of each causative condition and often caesarean delivery.
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