Suchergebnisse

BACKGROUND: Adequate gestational weight gain (GWG) is essential for healthy fetal growth. However, in low- and middle-income countries, where malnutrition is prevalent, little information is available about GWG and how it might be modified by nutritional status and interventions. OBJECTIVE: We describe GWG and its associations with fetal growth and birth outcomes. We also examined the extent to which prepregnancy BMI, and preconception and early weight gain modify GWG, and its effects on fetal growth. METHODS: This was a secondary analysis of the Women First Trial, including 2331 women within the Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan, evaluating weight gain from enrollment to ∼12 weeks of gestation and GWG velocity (kg/wk) between ∼12 and 32 weeks of gestation. Adequacy of GWG velocity was compared with 2009 Institute of Medicine recommendations, according to maternal BMI. Early weight gain (EWG), GWG velocity, and adequacy of GWG were related to birth outcomes using linear and Poisson models. RESULTS: GWG velocity (mean ± SD) varied by site: 0.22 ± 0.15 kg/wk in DRC, 0.30 ± 0.23 in Pakistan, 0.31 ± 0.14 in Guatemala, and 0.39 ± 0.13 in India, (P <0.0001). An increase of 0.1 kg/wk in maternal GWG was associated with a 0.13 cm (95% CI: 0.07, 0.18, P <0.001) increase in birth length and a 0.032 kg (0.022, 0.042, P <0.001) increase in birth weight. Compared to women with inadequate GWG, women who had adequate GWG delivered newborns with a higher mean length and weight: 47.98 ± 2.04 cm compared with 47.40 ± 2.17 cm (P <0.001) and 2.864 ± 0.425 kg compared with 2.764 ± 0.418 kg (P <0.001). Baseline BMI, EWG, and GWG were all associated with birth length and weight. CONCLUSIONS: These results underscore the importance of adequate maternal nutrition both before and during pregnancy as a potentially modifiable factor to improve fetal growth.

Introduction Neonatal mortality associated with preterm birth can be reduced with antenatal corticosteroids (ACS), yet 36.0 weeks GA. In phase 1, UH measurements were collected prospectively in the Democratic Republic of Congo, India and Pakistan, using distinct tapes to address variation across regions and ethnicities. In phase 2, we tested accuracy in 250 pregnant women with known GA from early ultrasound enrolled at prenatal clinics in Argentina, India, Pakistan and Zambia. Providers masked to the ultrasound GA measured UH. Receiver operating characteristics (ROC) analysis was conducted. Results 1,029 pregnant women were enrolled. In all countries the tapes were most effective identifying pregnancies between 20.0–35.6 weeks, compared to the other GAs. The ROC areas under the curves and 95% confidence intervals were: Argentina 0.69 (0.63, 0.74); Zambia 0.72 (0.66, 0.78), India 0.84 (0.80, 0.89), and Pakistan 0.83 (0.78, 0.87). The sensitivity and specificity (and 95% confidence intervals) for identifying pregnancies between 20.0–35.6 weeks, respectively, were: Argentina 87% (82%–92%) and 51% (42%–61%); Zambia 91% (86%–95%) and 50% (40%–60%); India 78% (71%–85%) and 89% (83%–94%); Pakistan 63% (55%–70%) and 94% (89%–99%). Conclusions We observed moderate-good accuracy identifying pregnancies ≤35.6 weeks gestation, with potential usefulness at the community level in low-middle income countries to facilitate the preterm identification and interventions to reduce preterm neonatal mortality. Further research is needed to validate these findings on a population basis.

Introduction: Neonatal mortality associated with preterm birth can be reduced with antenatal corticosteroids (ACS), yet 36.0 weeks GA. In phase 1, UH measurements were collected prospectively in the Democratic Republic of Congo, India and Pakistan, using distinct tapes to address variation across regions and ethnicities. In phase 2, we tested accuracy in 250 pregnant women with known GA from early ultrasound enrolled at prenatal clinics in Argentina, India, Pakistan and Zambia. Providers masked to the ultrasound GA measured UH. Receiver operating characteristics (ROC) analysis was conducted. Results: 1,029 pregnant women were enrolled. In all countries the tapes were most effective identifying pregnancies between 20.0-35.6 weeks, compared to the other GAs. The ROC areas under the curves and 95% confidence intervals were: Argentina 0.69 (0.63, 0.74); Zambia 0.72 (0.66, 0.78), India 0.84 (0.80, 0.89), and Pakistan 0.83 (0.78, 0.87). The sensitivity and specificity (and 95% confidence intervals) for identifying pregnancies between 20.0-35.6 weeks, respectively, were: Argentina 87% (82%-92%) and 51% (42%-61%); Zambia 91% (86%-95%) and 50% (40%-60%); India 78% (71%-85%) and 89% (83%-94%); Pakistan 63% (55%-70%) and 94% (89% -99%). Conclusions: We observed moderate-good accuracy identifying pregnancies ≤35.6 weeks gestation, with potential usefulness at the community level in low-middle income countries to facilitate the preterm identification and interventions to reduce preterm neonatal mortality. Further research is needed to validate these findings on a population basis. ; Fil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina ; Fil: Berrueta, Amanda Mabel. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Hemingway Foday, Jennifer. Rti International; Estados Unidos ; Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Bonorino, Carolina Astoul. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Gowdak, Andrea. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Bellad, M. B. Jawaharlal Nehru Medical College Belgaum; India ; Fil: Metgud, M. C. Jawaharlal Nehru Medical College Belgaum; India ; Fil: Goudar, Shivaprasad. Jawaharlal Nehru Medical College Belgaum; India ; Fil: Kodkany, Bhalchandra S. Jawaharlal Nehru Medical College Belgaum; India ; Fil: Derman, Richard J. Christiana Care Health System; Estados Unidos ; Fil: Saleem, Sarah. The Aga Khan University; Pakistán ; Fil: Iqbal, Samina. Sobhraj Maternity Hospital; Pakistán ; Fil: Ala, Syed Hasan. Sindh Government Qatar Hospital; Pakistán ; Fil: Goldenberg, Robert L. Columbia University; Estados Unidos ; Fil: Chomba, Elwyn. University Teaching Hospital Lusaka; Zambia ; Fil: Manasyan, Albert. University of North Carolina; Estados Unidos. Centre For Infectious Disease Research In Zambia; Zambia ; Fil: Chiwila, Melody. University Teaching Hospital Lusaka; Zambia ; Fil: Imenda, Edna. University Teaching Hospital Lusaka; Zambia ; Fil: Mbewe, Florence. University Teaching Hospital Lusaka; Zambia ; Fil: Tshefu, Antoinette. Kinshasa School Of Public Health; República Democrática del Congo ; Fil: Lokomba, Victor. Kinshasa School Of Public Health; República Democrática del Congo ; Fil: Bose, Carl L. University of North Carolina; Estados Unidos ; Fil: Moore, Janet. Rti International; Estados Unidos ; Fil: Meleth, Sreelatha. Rti International; Estados Unidos ; Fil: McClure, Elizabeth M. Rti International; Estados Unidos ; Fil: Koso Thomas, Marion. Eunice Kennedy Shriver NICHD; Estados Unidos ; Fil: Buekens, Pierre. University of Tulane; Estados Unidos ; Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina