ObjectiveThis study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women ...with infection during pregnancy in low-income and middle-income countries (LMIC).DesignWe conducted a 1-week inception hospital-based cohort study.SettingThe study was carried out in 408 hospitals in 43 LMIC of all the WHO regions in 2017.PatientsWe included women with suspected or confirmed infection during pregnancy with at least 28 weeks of gestational age up to day-7 after birth. All babies born to those women were followed from birth until the seventh day after childbirth. Perinatal outcomes were considered at the end of the follow-up.Main outcome measuresPerinatal outcomes were (i) babies alive without severe complication, (ii) NNM and (iii) perinatal death (stillbirth and early neonatal death).Results1219 births were analysed. Among them, 25.9% (n=316) and 10.1% (n=123) were NNM and perinatal deaths, respectively. After adjustment, maternal pre-existing medical condition (adjusted odds ratios (aOR)=1.5; 95% CI 1.1 to 2.0) and maternal infection suspected or diagnosed during labour (aOR=1.9; 95% CI 1.2 to 3.2) were the independent risk factors of NNM. Maternal pre-existing medical condition (aOR=1.7; 95% CI 1.0 to 2.8), infection-related severe maternal outcome (aOR=3.8; 95% CI 2.0 to 7.1), mother’s infection suspected or diagnosed within 24 hours after childbirth (aOR=2.2; 95% CI 1.0 to 4.7) and vaginal birth (aOR=1.8; 95% CI 1.1 to 2.9) were independently associated with increased odds of perinatal death.ConclusionsOverall, one-third of births were adverse perinatal outcomes. Pre-existing maternal medical conditions and severe infection-related maternal outcomes were the main risk factors of adverse perinatal outcomes.
Objective
To characterise the current clinical practice patterns regarding the use of magnesium sulphate (MgSO4) for eclampsia prevention and treatment in a multi‐country network of health facilities ...and compare with international recommendations.
Design
Cross‐sectional survey.
Setting
A total of 147 health facilities in 15 countries across Africa, Latin America and Asia.
Population
Heads of obstetric departments or maternity units.
Methods
Anonymous online and paper‐based survey conducted in 2015.
Main outcome measures
Availability and use of MgSO4; availability of a formal clinical protocol for MgSO4 administration; and MgSO4 dosing regimens for eclampsia prevention and treatment.
Results
Magnesium sulphate and a formal protocol for its administration were reported to be always available in 87.4% and 86.4% of all facilities, respectively. MgSO4 was used for the treatment of mild pre‐eclampsia, severe pre‐eclampsia and eclampsia in 24.3%, 93.5% and 96.4% of all facilities, respectively. Regarding the treatment of severe pre‐eclampsia, 26.4% and 7.0% of all facilities reported using dosing regimens that were consistent with Zuspan and Pritchard regimens, respectively. Across regions, intramuscular maintenance regimens were more commonly used in the African region (45.7%) than in the Latin American (3.0%) and Asian (22.9%) regions, whereas intravenous maintenance regimens were more often used in the Latin American (94.0%) and Asian (60.0%) regions than in the African region (21.7%). Similar patterns were found for the treatment of eclampsia across regions.
Conclusions
The reported clinical use of MgSO4 for eclampsia prevention and treatment varied widely, and was largely inconsistent with current international recommendations.
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MgSO4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations.
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MgSO4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations.
To report stillbirth and early neonatal mortality and to quantify the relative importance of different primary obstetric causes of perinatal mortality in 171 perinatal deaths from 7993 pregnancies ...that ended after 28 weeks in nulliparous women.
A review of all stillbirths and early newborn deaths reported in the WHO calcium supplementation trial for the prevention of pre-eclampsia conducted at seven WHO collaborating centres in Argentina, Egypt, India, Peru, South Africa and Viet Nam. We used the Baird-Pattinson system to assign primary obstetric causes of death and classified causes of early neonatal death using the International classification of diseases and related health problems, Tenth revision (ICD-10).
Stillbirth rate was 12.5 per 1000 births and early neonatal mortality rate was 9.0 per 1000 live births. Spontaneous preterm delivery and hypertensive disorders were the most common obstetric events leading to perinatal deaths (28.7% and 23.6%, respectively). Prematurity was the main cause of early neonatal deaths (62%).
Advancements in the care of premature infants and prevention of spontaneous preterm labour and hypertensive disorders of pregnancy could lead to a substantial decrease in perinatal mortality in hospital settings in developing countries.
Background: Effects of prenatal iron supplementation on maternal postpartum iron status and early infant iron homeostasis remain largely unknown.Objective: We examined iron absorption and growth in ...exclusively breastfed infants in relation to fetal iron exposure and iron status during early infancy.Design: Longitudinal, paired iron-absorption (58Fe) studies were conducted in 59 exclusively breastfed Peruvian infants at 2–3 mo of age (2M) and 5–6 mo of age (5M). Infants were born to women who received ≥5100 or ≤1320 mg supplemental prenatal Fe. Iron status was assessed in mothers and infants at 2M and 5M.Results: Infant iron absorption from breast milk averaged 7.1% and 13.9% at 2M and 5M. Maternal iron status (at 2M) predicted infant iron deficiency (ID) at 5M. Although no infants were iron deficient at 2M, 28.6% of infants had depleted iron stores (ferritin concentration <12 μg/L) by 5M. Infant serum ferritin decreased (P < 0.0001), serum transferrin receptor (sTfR) increased (P < 0.0001), and serum iron decreased from 2M to 5M (P < 0.01). Higher infant sTfR (P < 0.01) and breast-milk copper (P < 0.01) predicted increased iron absorption at 5M. Prenatal iron supplementation had no effects on infant iron status or breast-milk nutrient concentrations at 2M or 5M. However, fetal iron exposure predicted increased infant length at 2M (P < 0.01) and 5M (P < 0.05).Conclusions: Fetal iron exposure affected early infant growth but did not significantly improve iron status or absorption. Young, exclusively breastfed infants upregulated iron absorption when iron stores were depleted at both 2M and 5M.
OBJECTIVE: To report stillbirth and early neonatal mortality and to quantify the relative importance of different primary obstetric causes of perinatal mortality in 171 perinatal deaths from 7993 ...pregnancies that ended after 28 weeks in nulliparous women. METHODS: A review of all stillbirths and early newborn deaths reported in the WHO calcium supplementation trial for the prevention of pre-eclampsia conducted at seven WHO collaborating centres in Argentina, Egypt, India, Peru, South Africa and Viet Nam. We used the Baird-Pattinson system to assign primary obstetric causes of death and classified causes of early neonatal death using the International classification of diseases and related health problems, Tenth revision (ICD-10). FINDINGS: Stillbirth rate was 12.5 per 1000 births and early neonatal mortality rate was 9.0 per 1000 live births. Spontaneous preterm delivery and hypertensive disorders were the most common obstetric events leading to perinatal deaths (28.7% and 23.6%, respectively). Prematurity was the main cause of early neonatal deaths (62%). CONCLUSIONS: Advancements in the care of premature infants and prevention of spontaneous preterm labour and hypertensive disorders of pregnancy could lead to a substantial decrease in perinatal mortality in hospital settings in developing countries.
The purpose of this trial was to determine whether calcium supplementation of pregnant women with low calcium intake reduces preeclampsia and preterm delivery.
Randomized placebo-controlled, ...double-blinded trial in nulliparous normotensive women from populations with dietary calcium <600 mg/d. Women who were recruited before gestational week 20 received supplements (1.5 g calcium/d or placebo) throughout pregnancy. Primary outcomes were preeclampsia and preterm delivery; secondary outcomes focused on severe morbidity and maternal and neonatal mortality rates.
The groups comprised 8325 women who were assigned randomly. Both groups had similar gestational ages, demographic characteristics, and blood pressure levels at entry. Compliance were both 85% and follow-up losses (calcium, 3.4%; placebo, 3.7%). Calcium supplementation was associated with a non-statistically significant small reduction in preeclampsia (4.1% vs 4.5%) that was evident by 35 weeks of gestation (1.2% vs 2.8%;
P = .04). Eclampsia (risk ratio, 0.68: 95% CI, 0.48-0.97) and severe gestational hypertension (risk ratio, 0.71; 95% CI, 0.61-0.82) were significantly lower in the calcium group. Overall, there was a reduction in the severe preeclamptic complications index (risk ratio, 0.76; 95% CI, 0.66-0.89; life-table analysis, log rank test;
P = .04). The severe maternal morbidity and mortality index was also reduced in the supplementation group (risk ratio, 0.80; 95% CI, 0.70-0.91). Preterm delivery (the neonatal primary outcome) and early preterm delivery tended to be reduced among women who were ≤20 years of age (risk ratio, 0.82; 95% CI, 0.67-1.01; risk ratio, 0.64; 95% CI, 0.42-0.98, respectively). The neonatal mortality rate was lower (risk ratio, 0.70; 95% CI, 0.56-0.88) in the calcium group.
A 1.5-g calcium/day supplement did not prevent preeclampsia but did reduce its severity, maternal morbidity, and neonatal mortality, albeit these were secondary outcomes.
Pregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection ...and country income, among hospitalized women with suspected or confirmed pregnancy-related infections.
We used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women.
We found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries.
Differences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.
Our objective was to test whether intrauterine growth in the second half of pregnancy is associated with anthropometric and body composition measures in early childhood. We used data from a prenatal ...zinc supplementation trial in Peru (n=177) to estimate fetal growth using serial ultrasound measures of head circumference, abdominal circumference, femur diaphysis length, and estimated fetal weight (20‐38 wk gestation), and measures of growth and body composition (weight, height, body mass index (BMI), waist circumference, sum of skinfolds, and fat and muscle areas of extremities) evaluated at a follow‐up visit at 4.5 y. We constructed separate linear regression models for each fetal size measure in mid‐gestation (20‐24 wk), end of pregnancy (36‐38 wk), and the net difference between them and each measure of growth and body composition in childhood. In models adjusted for child and maternal factors, measures of fetal size at end of pregnancy and the difference in fetal size between mid‐gestation and end of pregnancy were positively associated with measures of growth, adiposity, and lean body mass at 4.5y. None of the fetal size measures in mid‐pregnancy were associated with child size or body composition. These results suggest that the fetal growth during the final few weeks of pregnancy influences size and body composition in early childhood.
Grant Funding Source: Supported by Nestle Research Foundation; HD042675; NICHD; American Heart Association
Abstract only
This study aimed to investigate: growth velocity patterns in Peruvian infants; determinants of velocities during critical periods; and anthropometric outcomes at 12 mo predicted by ...velocities. From 1995–1997, an RCT of maternal zinc supplementation was conducted in a periurban slum area of Lima. 579 infants were followed monthly through 12 mo on a range of anthropometric measures. We examined 3 types of velocity variables: incremental velocity (1 mo, 2 mo, and 6 mo); 2) proportional changes (% of total size gained/mo); and 3) individual velocity variability (SD of child incremental velocities). Mean within‐child SD of weight velocity was 0.42 kg (±0.12). Growth velocities in month 1 and variable weight velocity positively predicted attained height and weight by 12 mo in multivariate regression analyses. Panel regression by generalized least‐squared of height and weight velocities confirmed the exponentially decelerating pace of growth through infancy and the importance of birth size in driving this trajectory. Arm fat area was a significant determinant of length gain in the same month. Boys grew more rapidly than girls in the first half of infancy, but not in proportion to the total incremental gain. This study contributes evidence to support the importance of early growth velocities and greater degrees of weight gain plasticity for attained height and weight. The study was funded by USAID and NIH.
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