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ELife Jun 2024Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. Most cases of preterm birth occur spontaneously and result from preterm labor with...
BACKGROUND
Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. Most cases of preterm birth occur spontaneously and result from preterm labor with intact (spontaneous preterm labor [sPTL]) or ruptured (preterm prelabor rupture of membranes [PPROM]) membranes. The prediction of spontaneous preterm birth (sPTB) remains underpowered due to its syndromic nature and the dearth of independent analyses of the vaginal host immune response. Thus, we conducted the largest longitudinal investigation targeting vaginal immune mediators, referred to herein as the immunoproteome, in a population at high risk for sPTB.
METHODS
Vaginal swabs were collected across gestation from pregnant women who ultimately underwent term birth, sPTL, or PPROM. Cytokines, chemokines, growth factors, and antimicrobial peptides in the samples were quantified via specific and sensitive immunoassays. Predictive models were constructed from immune mediator concentrations.
RESULTS
Throughout uncomplicated gestation, the vaginal immunoproteome harbors a cytokine network with a homeostatic profile. Yet, the vaginal immunoproteome is skewed toward a pro-inflammatory state in pregnant women who ultimately experience sPTL and PPROM. Such an inflammatory profile includes increased monocyte chemoattractants, cytokines indicative of macrophage and T-cell activation, and reduced antimicrobial proteins/peptides. The vaginal immunoproteome has improved predictive value over maternal characteristics alone for identifying women at risk for early (<34 weeks) sPTB.
CONCLUSIONS
The vaginal immunoproteome undergoes homeostatic changes throughout gestation and deviations from this shift are associated with sPTB. Furthermore, the vaginal immunoproteome can be leveraged as a potential biomarker for early sPTB, a subset of sPTB associated with extremely adverse neonatal outcomes.
FUNDING
This research was conducted by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS) under contract HHSN275201300006C. ALT, KRT, and NGL were supported by the Wayne State University Perinatal Initiative in Maternal, Perinatal and Child Health.
Topics: Humans; Female; Longitudinal Studies; Pregnancy; Vagina; Premature Birth; Adult; Retrospective Studies; Proteome; Cytokines; Fetal Membranes, Premature Rupture; Young Adult; Immunoproteins
PubMed: 38913421
DOI: 10.7554/eLife.90943 -
Frontiers in Global Women's Health 2024Home delivery, which is the process of childbirth at one's residence rather than in a health facility, is a major reason for maternal mortality caused by obstetric...
INTRODUCTION
Home delivery, which is the process of childbirth at one's residence rather than in a health facility, is a major reason for maternal mortality caused by obstetric complications, such as sepsis, hypertensive disorders, and hemorrhage. Maternal and child mortality remains high in developing countries despite efforts made to reduce these outcomes. This is mainly due to poor utilization of institution-based healthcare services. Moreover, there is a limited number of studies that have addressed the determinants of home delivery in Ethiopia, including the study area. This study aims to identify the determinants of home delivery in Bore District, East Guji Zone, Southern Ethiopia, in 2022.
METHODS
A community-based unmatched case-control study was conducted from 18 May to 5 July 2022 among 498 women (249 cases and 249 controls) who gave birth in Bore District. The case group included women who gave birth at home, while the control group included those who gave their last birth at health institutions. A multistage sampling technique was employed to select the study participants. Data were collected using the KoboToolbox digital software and exported to SPSS Version 26.0 for analysis. A multivariable logistic regression analysis was done to declare the statistical significance of the association of the the independent variables and home delivery.
RESULTS
The study included a total of 496 respondents with a mean age of 32.5 (SD = ±5.5) for the case group and 33.7 (SD = ±5.2) for the control group. Among the assessed determinants of home delivery were not attending antenatal care (ANC) visits [adjusted odds ratio (AOR) = 5.6, 95% CI: 2.0-15.16], missing pregnant women's conferences (AOR = 3.2, 95% CI: 1.65-8.32), not receiving health education on pregnancy-related complications (AOR = 2.2, 95% CI: 1.1-4.3), inadequate knowledge of pregnancy-related danger signs (AOR = 6.0, CI: 3.0-11.9), inadequate knowledge about pregnancy-related complications (AOR = 3.0, CI: 1.55-6.13), and unfavorable attitude (AOR = 6.9, 95% CI: 2.16-22.6).
CONCLUSION
In this study, not attending ANC visits, missing pregnant women's conferences, not receiving health education on pregnancy-related complications, inadequate knowledge of pregnancy-related danger signs, inadequate knowledge about pregnancy-related complications, and unfavorable attitudes were identified as determinants of home delivery. The district health office and other stakeholders should work on strengthening maternal health service delivery through appropriate ANC visits and participation in pregnant women's conferences and improving community awareness about pregnancy at all levels.
PubMed: 38912412
DOI: 10.3389/fgwh.2024.1236758 -
Frontiers in Nutrition 2024The burden of ischemic stroke (IS) linked to high consumption of red meat is on the rise. This study aimed to analyze the mortality and disability-adjusted life years...
BACKGROUND
The burden of ischemic stroke (IS) linked to high consumption of red meat is on the rise. This study aimed to analyze the mortality and disability-adjusted life years (DALYs) trends for IS attributed to high red meat intake in China between 1990 and 2019 and to compare these trends with global trends.
METHODS
This study extracted data on IS attributed to diets high in red meat in China from 1990 to 2019 from the Global Burden of Disease Study (GBD) database. Key measures, including mortality, DALYs, age-standardized mortality rates (ASMR), and age-standardized DALYs rates (ASDR), were used to estimate the disease burden. The estimated annual percentage change and joinpoint regression models were employed to assess the trends over time. An age-period-cohort analysis was used to assess the contribution of a diet high in red meat to the age, period, and cohort effects of IS ASMR and ASDR.
RESULTS
Between 1990 and 2019, deaths and DALYs from IS attributed to a diet high in red meat in China, along with corresponding age-standardized rates, significantly increased. The overall estimated annual percentage change for the total population and across sex categories ranged from 1.01 to 2.08. The average annual percentage changes for overall ASDR and ASMR were 1.4 and 1.33, respectively, with male ASDR and ASMR average annual percentage changes at 1.69 and 1.69, respectively. Contrastingly, female ASDR and ASMR average annual percentage changes were 1.07 and 0.87, respectively. Except for a few periods of significant decrease in females, all other periods indicated a significant increase or nonsignificant changes. Incidence of IS linked to a diet high in red meat rose sharply with age, displaying increasing period and cohort effects in ASDR. Female ASMR period and cohort effect ratios initially increased and then decreased, whereas the male ratio showed an upward trend.
CONCLUSION
This study comprehensively analyzed epidemiological characteristics that indicated a marked increase in mortality and DALYs from IS attributable to high red meat consumption, contrasting with a global downtrend. This increase was more pronounced in males than females. This research provides valuable insights for enhancing IS prevention in China.
PubMed: 38912303
DOI: 10.3389/fnut.2024.1384023 -
SAGE Open Medicine 2024Puerperal sepsis is a leading cause of maternal morbidity and mortality in low-income countries, which can affect sustainable development goals. Even though it is a...
INTRODUCTION
Puerperal sepsis is a leading cause of maternal morbidity and mortality in low-income countries, which can affect sustainable development goals. Even though it is a preventable problem through maternal self-care practices, maternal-reported self-care practices regarding puerperal sepsis were under-researched in Ethiopia. Therefore, this study aimed to assess the maternal reported self-care practice and associated factors among postnatal mothers for the prevention of puerperal sepsis.
OBJECTIVE
The study aimed to assess the reported self-care practice of postnatal mothers in Arba Minch town toward the prevention of puerperal sepsis and its associated factors.
METHODS
A community-based cross-sectional study was employed from 1st to 30th May 2022. Study participants were selected using a simple random sampling technique. Data was collected by the Open Data Kit tool and exported to SPSS version 26 for further analysis. Both crude and adjusted odds ratios with a 95% CI were calculated, and a -value of less than 0.05 was used to declare statistically significant factors.
RESULTS
Of a total of 423 postpartum mothers, 417 participated, making a response rate of 98.5%. The study revealed that 45.6% (95% CI: 41.2%, 50.1%) of postnatal mothers had good reported self-care practices toward the prevention of puerperal sepsis. Tertiary educational level (AOR: 2.56; 95% CI: 1.43, 4.59), multiparity (AOR: 0.44; 95% CI: 0.26, 0.74), and having a good awareness of puerperal sepsis prevention (AOR: 2.17; 95% CI: 1.40, 3.37) were significantly associated at a -value less than 0.05.
CONCLUSION
This study revealed that less than half of postnatal mothers reported good self-care practices. Healthcare providers and all stakeholders should focus on strategies to improve self-care practice during antenatal and postnatal care and at a community level, with a special focus on postnatal mothers with no formal education and multiparous mothers.
PubMed: 38911439
DOI: 10.1177/20503121241257150 -
Gynecology and Minimally Invasive... 2024Cesarean scar ectopic pregnancy is a leading cause of life-threatening complications in the first trimester. It poses a diagnostic and management challenge; if not...
Cesarean scar ectopic pregnancy is a leading cause of life-threatening complications in the first trimester. It poses a diagnostic and management challenge; if not diagnosed and adequately treated in early pregnancy, it may lead to considerable maternal morbidity and mortality. We report a case series of cesarean scar ectopic pregnancies managed successfully by laparoscopy. Laparoscopic excision is the gold standard management approach for cesarean scar ectopic pregnancy.
PubMed: 38911309
DOI: 10.4103/gmit.gmit_83_23 -
Proceedings (Baylor University. Medical... 2024The available literature indicates a link between SARS-CoV-2 infection during pregnancy and a heightened probability of experiencing negative outcomes for both the...
BACKGROUND
The available literature indicates a link between SARS-CoV-2 infection during pregnancy and a heightened probability of experiencing negative outcomes for both the pregnant patient and the developing fetus. We compared clinical outcomes of pregnant patients with or without COVID-19 hospitalized during delivery.
METHODS
Multivariate logistic regression analysis was used to compare outcomes and was adjusted for patient-related, hospital-related, and illness severity indicators.
RESULTS
We identified a total of 3,447,771 pregnant patients admitted between January 1, 2020 and December 31, 2020; 1.3% (n = 46,050) had COVID-19. COVID-19-positive patients had higher rates of in-hospital mortality (0.15% vs 0.05%, adjusted odds ratio [aOR] 5.97, 95% confidence interval [CI] 2.5-14.25, < 0.001), mechanical ventilation (0.9% vs 0.05%, aOR 14.2, 95% CI 10.7-18.76, < 0.001), vasopressor use (0.26% vs 0.14%, aOR 1.47, 95% CI 1.07-2.02, = 0.01), and perinatal maternal complications like preeclampsia (9.66% vs 7.04%, aOR 1.29, 95% CI 1.2-1.39, < 0.001) and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome (0.53% vs 0.26%, aOR 1.93, 95% CI 1.43-2.61, < 0.001) than COVID-19-negative patients.
DISCUSSION
Clinicians should be aware of the heightened risk of complications in pregnant patients with COVID-19 and consider strategies to mitigate them.
PubMed: 38910793
DOI: 10.1080/08998280.2024.2347738 -
Cureus May 2024Ectopic pregnancy is a significant cause of maternal morbidity and mortality in women of reproductive age group. Tubal ectopic in an unstable patient is a medical...
Ectopic pregnancy is a significant cause of maternal morbidity and mortality in women of reproductive age group. Tubal ectopic in an unstable patient is a medical emergency. Tubal stump ectopic is a rare presentation. It is difficult to diagnose. Early diagnosis can prevent significant morbidity and mortality. Here, we present a case of ruptured tubal stump ectopic pregnancy in a 33-year-old female who had undergone salpingectomy previously for ectopic pregnancy.
PubMed: 38910636
DOI: 10.7759/cureus.60859 -
International Journal For Equity in... Jun 2024Women's access to legal and safe abortion is a vital means to reduce unsafe abortion, which in turn is known to reduce maternal morbidity and mortality. In 2005,...
INTRODUCTION
Women's access to legal and safe abortion is a vital means to reduce unsafe abortion, which in turn is known to reduce maternal morbidity and mortality. In 2005, Ethiopia enacted a relatively permissive abortion legislation. However, there is evidence that access to abortion care services may be challenging and controversial even if progressive abortion laws are in place. This article examines women's access to abortion services from the perspective of healthcare workers in a rural setting in Ethiopia. Drawing on Lipsky's theory of street-level bureaucrats, the article discusses healthcare workers' discretion and the substantial authority they hold as gatekeepers to safe abortion services.
METHODS
The study draws upon a qualitative, interpretative methodological approach, with in-depth semi-structured interviews with healthcare workers as the key method of data generation. The data was analyzed and interpreted thematically. Healthcare workers' perspectives were examined with reference to the national abortion legislation and guidelines.
RESULTS
The findings reveal that healthcare workers make decisions on behalf of the women who seek abortion, and they involve parents and partners in abortion-related decision-making processes. Moreover, they assess the social context of the pregnancy such as the marital and economic statuses of the abortion-seeking women in ways that restrict women's access to legally-endorsed abortion services.
CONCLUSIONS
Healthcare workers' practices in this rural area were found to challenge the basic provisions laid out in Ethiopia's abortion legislation. Their negative discretion of the legislation contributes to the substantial barriers Ethiopian abortion-seeking women face in gaining access to legal abortion services, despite the presence of a progressive legal framework and guidelines.
Topics: Humans; Ethiopia; Female; Health Services Accessibility; Pregnancy; Health Personnel; Qualitative Research; Abortion, Induced; Adult; Decision Making; Attitude of Health Personnel; Abortion, Legal; Interviews as Topic
PubMed: 38907223
DOI: 10.1186/s12939-024-02203-6 -
BMJ Paediatrics Open Jun 2024We conducted a propensity score-matched multivariable regression analysis of 1050 culture-negative neonatal sepsis cases in Malawi, where 160 (15.2%) died. Mortality...
We conducted a propensity score-matched multivariable regression analysis of 1050 culture-negative neonatal sepsis cases in Malawi, where 160 (15.2%) died. Mortality among neonates with culture-negative sepsis was associated with very low birth weight (adjusted OR (AOR) 12.82, 95% CI 1.23 to 137.49), respiratory distress syndrome (AOR 13.20, 95% CI 2.58 to 83.66), a low Apgar score at 1 min (AOR 3.50, 95% CI 1.21 to 10.72) and at 5 min (AOR 4.77, 95% CI 1.94 to 12.50). Addressing maternal and perinatal factors around health and delivery of care is key to improving outcomes in the context of culture-negative sepsis in neonates from low-income country settings like Malawi.
Topics: Humans; Malawi; Infant, Newborn; Neonatal Sepsis; Propensity Score; Female; Risk Factors; Male; Apgar Score; Infant, Very Low Birth Weight; Respiratory Distress Syndrome, Newborn
PubMed: 38906562
DOI: 10.1136/bmjpo-2024-002664 -
ELife Jun 2024Maternal choline supplementation (MCS) improves cognition in Alzheimer's disease (AD) models. However, the effects of MCS on neuronal hyperexcitability in AD are...
Maternal choline supplementation (MCS) improves cognition in Alzheimer's disease (AD) models. However, the effects of MCS on neuronal hyperexcitability in AD are unknown. We investigated the effects of MCS in a well-established mouse model of AD with hyperexcitability, the Tg2576 mouse. The most common type of hyperexcitability in Tg2576 mice are generalized EEG spikes (interictal spikes [IIS]). IIS also are common in other mouse models and occur in AD patients. In mouse models, hyperexcitability is also reflected by elevated expression of the transcription factor ∆FosB in the granule cells (GCs) of the dentate gyrus (DG), which are the principal cell type. Therefore, we studied ΔFosB expression in GCs. We also studied the neuronal marker NeuN within hilar neurons of the DG because reduced NeuN protein expression is a sign of oxidative stress or other pathology. This is potentially important because hilar neurons regulate GC excitability. Tg2576 breeding pairs received a diet with a relatively low, intermediate, or high concentration of choline. After weaning, all mice received the intermediate diet. In offspring of mice fed the high choline diet, IIS frequency declined, GC ∆FosB expression was reduced, and hilar NeuN expression was restored. Using the novel object location task, spatial memory improved. In contrast, offspring exposed to the relatively low choline diet had several adverse effects, such as increased mortality. They had the weakest hilar NeuN immunoreactivity and greatest GC ΔFosB protein expression. However, their IIS frequency was low, which was surprising. The results provide new evidence that a diet high in choline in early life can improve outcomes in a mouse model of AD, and relatively low choline can have mixed effects. This is the first study showing that dietary choline can regulate hyperexcitability, hilar neurons, ΔFosB, and spatial memory in an animal model of AD.
Topics: Animals; Alzheimer Disease; Choline; Disease Models, Animal; Mice; Dietary Supplements; Female; Mice, Transgenic; Proto-Oncogene Proteins c-fos; Neurons; Male; Dentate Gyrus; Nerve Tissue Proteins; DNA-Binding Proteins
PubMed: 38904658
DOI: 10.7554/eLife.89889