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Original Articles
Maternal pre-pregnancy anemia and childhood anemia in Indonesia: a risk assessment using a population-based prospective longitudinal study
Fadila Wirawan, Dieta Nurrika
Epidemiol Health. 2022;44:e2022100.   Published online November 1, 2022
DOI: https://doi.org/10.4178/epih.e2022100
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  • 2 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Anemia in children under 5 years of age is often overlooked despite its detrimental effects. The public health approach to anemia prevention includes the maternal pre-pregnancy phase. This study investigated the association between pre-pregnancy anemia and the risk of anemia in children under 5 years of age.
METHODS
This cohort study included non-pregnant women from the 2007 Indonesian Family Life Survey (IFLS) and their children under 5 in the 2014 IFLS. The anemia status of mothers and children was determined based on hemoglobin (Hb) levels using Hemocue. Mantel-Haenszel adjusted relative risks (aRRs), including risk stratification by covariates, were used for the final risk assessment.
RESULTS
In total, 637 children in the 2014 IFLS were included. The risk of having a child with anemia was 1.71-fold higher in women with pre-pregnancy anemia than in women without pre-pregnancy anemia (aRR, 1.71; 95% confidence interval [CI], 1.03 to 2.85). After risk stratification based on potential confounding variables, maternal pre-pregnancy anemia remained an independent risk factor for anemia in children who still breastfed at the time of data collection (relative risk [RR], 2.11; 95% CI, 1.16 to 3.86), in children who were given water earlier than 6 months of age (RR, 2.08; 95% CI, 1.20 to 3.61), in children of mothers with a normal or underweight pre-pregnancy body mass index (RR, 1.94; 95% CI, 1.20 to 3.14), and in children of mothers without current anemia (RR, 2.20; 95% CI, 1.21 to 3.99).
CONCLUSIONS
Pre-pregnancy anemia increased the risk of childhood anemia. A public health approach emphasizing pre-conception maternal health would enable better maternal and child morbidity risk prevention.
Summary
Key Message
Pre-pregnancy anemia increased the risk of childhood anemia by 1.7 times compared to without pre-pregnancy anemia, and increased when the child was still breastfed, given water before 6 months of age, and the mother had a normal or underweight pre-pregnancy BMI, regardless of the mother’s current no anemia status.

Citations

Citations to this article as recorded by  
  • Identification and treatment of iron‐deficiency anemia in pregnancy and postpartum: A systematic review and quality appraisal of guidelines using AGREE II
    Victoria Mintsopoulos, Evan Tannenbaum, A. Kinga Malinowski, Nadine Shehata, Melissa Walker
    International Journal of Gynecology & Obstetrics.2023;[Epub]     CrossRef
  • Prevalence and risk factors of anemia in the mother–child population from a region of the Colombian Caribbean
    Lisetta Del Castillo, Nora Cardona-Castro, Denis R. Whelan, John Paul Builes, Héctor Serrano-Coll, Margarita Arboleda, Juan S. Leon
    BMC Public Health.2023;[Epub]     CrossRef
Association between early antenatal care and antenatal care contacts across low-and middle-income countries: effect modification by place of residence
Paschal Awingura Apanga, Maxwell Tii Kumbeni
Epidemiol Health. 2021;43:e2021092.   Published online November 2, 2021
DOI: https://doi.org/10.4178/epih.e2021092
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  • 2 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The relationship between receiving early antenatal care (ANC) and 8 or more antenatal contacts (ANC8+) has not been well characterised across low-and middle-income countries (LMICs). It is also unclear whether the association between early ANC and ANC8+ is modified by a woman’s place of residence. Our primary aim was to assess the relationship between early ANC and ANC8+ and to investigate whether this relationship was modified by place of residence. We also estimated the coverage of ANC8+ across LMICs.
METHODS
We analysed data on 207,388 mothers with a recent live birth using multiple indicator cluster surveys conducted between 2017 and 2020 in 30 LMICS. Modified Poisson regression with robust variance was used to evaluate the relationship between early ANC and ANC8+, whilst adjusting for country, clustering, stratification, and sampling weights. Effect modification by place of residence was assessed on additive and multiplicative scales. A meta-analysis was conducted to pool prevalence estimates of ANC8+ across all countries.
RESULTS
The overall prevalence of ANC8+ was 35.6%, ranging from 1.7% in Madagascar to 99.4% in Belarus. Early ANC was positively associated with ANC8+ (adjusted prevalence ratio [aPR], 2.61; 95% confidence interval [CI], 1.82 to 3.74). There was evidence of positive effect modification on additive (relative excess risk due to interaction, 0.39; 95% CI, 0.35 to 0.44) and multiplicative (aPR, 1.78; 95% CI, 1.08 to 2.95) scales.
CONCLUSIONS
Many LMICs may not have adopted the 2016 World Health Organization guidelines on ANC8+. Receiving early ANC was associated with a higher likelihood of ANC8+, particularly for women in rural areas.
Summary
Key Message
Our findings suggest that early antenatal care (ANC) was associated with the likelihood of receiving eight or more ANC contacts (ANC8+) among all mothers across low-and middle-income countries. This association was modified by a woman’s place of residence such that mothers living in rural areas who received early ANC had a higher prevalence of ANC8+. Public health programs, which focus on increasing the coverage of ANC8+ should encourage all pregnant women to receive early ANC, particularly those living rural areas.

Citations

Citations to this article as recorded by  
  • Determinants of Focused Antenatal Care Utilization Among Women in Simiyu Region Tanzania
    Agatha F. Ngowi, Serafina Mkuwa, Laura Shirima, Frida Ngalesoni, Gasto Frumence
    SAGE Open Nursing.2023; 9: 237796082311707.     CrossRef
  • The moderating role of partners’ education on early antenatal care in northern Ghana
    Paschal Awingura Apanga, Maxwell Tii Kumbeni, James Kotuah Sakeah, Ayokunle A. Olagoke, Olufemi Ajumobi
    BMC Pregnancy and Childbirth.2022;[Epub]     CrossRef
COVID-19: Perspective
Maternal mental health in Africa during the COVID-19 pandemic: a neglected global health issue
Kobi V. Ajayi, Elizabeth Wachira, Obasanjo Afolabi Bolarinwa, Beulah D. Suleman
Epidemiol Health. 2021;43:e2021078.   Published online October 6, 2021
DOI: https://doi.org/10.4178/epih.e2021078
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  • 143 Download
  • 2 Citations
AbstractAbstract AbstractSummary PDF
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted mental health and well-being around the globe. Public health measures to control the virus’s rapid spread, such as physical distancing, social isolation, lockdown, restricted movements, and quarantine, caused fear and panic in the general population. Although pandemic-related stressors have been reported, changes that occur during the perinatal period compounded by those made to obstetric care guidelines may put pregnant and postpartum mothers at an increased risk of poor mental health. While an abundance of research has examined the impact of the pandemic on maternal mental health in developed nations such as Europe and America, very few studies have done so in the African continent. Considering that Africa has prominently weak health systems, poor mental health policies and infrastructure, high poverty rates, and unreliable maternal care, the pandemic is expected to have dire consequences on maternal mental health in the region. As such, multipronged mental health interventions and strategies that consider the heterogeneity within and between African regions must be developed. Doing so will close existing and widening global health disparities to achieve the United Nations Sustainable Development Goals by 2030.
Summary
Key Message
Despite the adverse psychological impact of the COVID-19 pandemic on maternal mental health globally, little is known about its effect in Africa. As of the time of this study, only four research studies have been conducted in Nigeria, Ethiopia, and Ghana, investigating the psychological sequelae of the pandemic among pregnant and postpartum women in Africa. This study calls for urgent multipronged maternal mental health interventions and psychosocial support that consider the heterogeneity within and between African regions.

Citations

Citations to this article as recorded by  
  • Experiences of Perinatal Mental Health Care among Minority Ethnic Women during the COVID-19 Pandemic in London: A Qualitative Study
    Sabrina Pilav, Abigail Easter, Sergio A. Silverio, Kaat De Backer, Sushma Sundaresh, Sara Roberts, Louise M. Howard
    International Journal of Environmental Research and Public Health.2022; 19(4): 1975.     CrossRef
  • Generalized Anxiety Disorder and Its Associated Factors Among Pregnant Women During COVID-19 at Public Health Facilities of East Gojjam Zone, 2020: A Multi-Center Cross-Sectional Study
    Keralem Anteneh Bishaw, Addisu Andalem, Haile Amha, Tirusew wondie
    Frontiers in Global Women's Health.2022;[Epub]     CrossRef
Cohort Profile
Cohort profile: congenital Zika virus infection and child neurodevelopmental outcomes in the ZEN cohort study in Colombia
Maritza Gonzalez, Van T. Tong, Helena Rodriguez, Diana Valencia, Jacqueline Acosta, Margaret A. Honein, Martha L. Ospina
Epidemiol Health. 2020;42:e2020060.   Published online August 31, 2020
DOI: https://doi.org/10.4178/epih.e2020060
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  • 3 Citations
AbstractAbstract PDF
Abstract
Zika en Embarazadas y Niños (ZEN) is a prospective cohort study designed to identify risk factors and modifiers for Zika virus (ZIKV) infection in pregnant women, partners, and infants, as well as to assess the risk for adverse maternal, fetal, infant, and childhood outcomes of ZIKV and other congenital infections. ZIKV infection during pregnancy may be associated with longterm sequelae. In the ZEN cohort, 1,519 pregnant women and 287 partners were enrolled from 3 departments within Colombia between February 2017 and January 2018, as well as 1,108 infants born to the pregnant women who were followed to 6 months. The data include baseline questionnaires at enrollment; repeated symptoms and study follow-up questionnaires; the results of lab tests to detect ZIKV and other congenital infections; medical record abstractions; infant physical, eye, and hearing exams; and developmental screening tests. Follow-up of 850 mother-child dyads occurred at 9 months, 12 months, and 18 months with developmental screenings, physical exams, and parent questionnaires. The data will be pooled with those from other prospective cohort studies for an individual participant data meta-analysis of ZIKV infection during pregnancy to characterize pregnancy outcomes and sequelae in children.
Summary

Citations

Citations to this article as recorded by  
  • Zika virus knowledge, attitudes and prevention behaviors among pregnant women in the ZEN cohort study, Colombia, 2017–2018
    Veronica K Burkel, Suzanne M Newton, Jacqueline Acosta, Diana Valencia, Monica Benavides, Van T Tong, Marcela Daza, Christina Sancken, Maritza Gonzalez, Kara Polen, Helena Rodriguez, Milena Borbón, Carol Y Rao, Suzanne M Gilboa, Margaret A Honein, Marta L
    Transactions of The Royal Society of Tropical Medicine and Hygiene.2023; 117(7): 496.     CrossRef
  • Epidemiology of cytomegalovirus Infection among mothers and infants in Colombia
    Angelica Rico, Sheila C. Dollard, Diana Valencia, Sheryll Corchuelo, Van T. Tong, Katherine Laiton‐Donato, Minal M. Amin, Monica Benavides, Phili Wong, Suzanne Newton, Marcela Daza, Jordan Cates, Maritza Gonzalez, Laura D. Zambrano, Marcela M. Mercado, El
    Journal of Medical Virology.2021; 93(11): 6393.     CrossRef
  • Causes of Phenotypic Variability and Disabilities after Prenatal Viral Infections
    Youssef A. Kousa, Reafa A. Hossain
    Tropical Medicine and Infectious Disease.2021; 6(2): 95.     CrossRef
Review
Rapid qualitative review of ethical issues surrounding healthcare for pregnant women or women of reproductive age in epidemic outbreaks
Patrik Hummel, Abha Saxena, Corinna Klingler
Epidemiol Health. 2018;40:e2018003.   Published online January 23, 2018
DOI: https://doi.org/10.4178/epih.e2018003
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  • 1 Citations
AbstractAbstract PDFSupplementary Material
Abstract
This article describes, categorizes, and discusses the results of a rapid literature review aiming to provide an overview of the ethical issues and corresponding solutions surrounding pregnancies in epidemic outbreaks. The review was commissioned by the World Health Organization to inform responses to the Zika outbreak that began in 2015. Due to the urgency of the response efforts that needed to be informed by the literature search, a rapid qualitative review of the literature published in PubMed was conducted. The search and analysis were based on the operationalization of 3 key concepts: ethics, pregnancy, and epidemic outbreak. Ethical issues and solutions were interpreted within a principlist framework. The data were analyzed using qualitative content analysis. The search identified 259 publications, of which the full text of 23 papers was read. Of those, 20 papers contained a substantive part devoted to the topic of interest and were therefore analyzed further. We clustered the ethical issues and solutions around 4 themes: uncertainty, harms, autonomy/liberty, and effectiveness. Recognition of the identified ethical issues and corresponding solutions can inform and improve response efforts, public health planning, policies, and decision-making, as well as the activities of medical staff and counselors who practice before, during, or after an epidemic outbreak that affects pregnant women or those of reproductive age. The rapid review format proved to be useful despite its limited data basis and expedited review process.
Summary

Citations

Citations to this article as recorded by  
  • How often is the placenta included in human pregnancy research? A rapid systematic review of the literature
    Leigh A. Taylor, Kelly Gallagher, Katherine A. Ott, Alison D. Gernand
    Gates Open Research.2021; 5: 38.     CrossRef
Original Articles
Exposure to pistachio pesticides and stillbirth: a case-control study
Saeid Razi, Mohsen Rezaeian, Fatemeh Ghani Dehkordi, Azita Manshoori, Reza Goujani, Reza Vazirinejad
Epidemiol Health. 2016;38:e2016016.   Published online April 30, 2016
DOI: https://doi.org/10.4178/epih.e2016016
  • 14,155 View
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  • 4 Citations
AbstractAbstract PDF
Abstract
OBJECTIVES
Stillbirth is an undesirable outcome of pregnancy. In light of the increasing use of pesticides and growing concerns about the possible health effects of agricultural pesticides, we investigated the effect of exposure to pistachio pesticides on stillbirth in pregnant mothers.
METHODS
This case-control study was conducted in Rafsanjan, Iran from 2011 to 2012. A total of 125 females who had a recent stillbirth were included as the case group, and 250 controls were selected from females who had a recent live birth. For each case, two controls with the nearest propensity score to the case were selected. Data were collected using a protocol developed by the researcher that involved interviewing respondents and reviewing their medical records. Conditional multivariate and univariate logistic regression analysis were performed and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
RESULTS
The ORs of stillbirth in mothers living in pistachio gardens and those who were exposed to sprayed pesticides, in comparison to the controls, were 14.1 (95% CI, 3.3 to 63.4) and 5.0 (95% CI, 1.2 to 28.6), respectively. No significant differences were found in stillbirth rates according to the distance between the mother’s residence and a pistachio garden or involvement in agricultural activities.
CONCLUSIONS
The results of our study showed that exposure to pistachio pesticides during pregnancy may increase the likelihood of stillbirth in mothers.
Summary

Citations

Citations to this article as recorded by  
  • Dietary zinc intake and body mass index as modifiers of the association between household pesticide exposure and infertility among US women: a population-level study
    Jungao Huang, Liqin Hu, Juan Yang
    Environmental Science and Pollution Research.2022; 30(8): 20327.     CrossRef
  • Glyphosate Herbicide: Reproductive Outcomes and Multigenerational Effects
    María Mercedes Milesi, Virginia Lorenz, Milena Durando, María Florencia Rossetti, Jorgelina Varayoud
    Frontiers in Endocrinology.2021;[Epub]     CrossRef
  • Pestizidrückstände in Gemüse und Obst und Outcome bei Frauen unter ART
    Constanze Banz-Jansen
    Gynäkologische Endokrinologie.2018; 16(2): 128.     CrossRef
  • Perinatal exposure to a glyphosate-based herbicide impairs female reproductive outcomes and induces second-generation adverse effects in Wistar rats
    María M. Milesi, Virginia Lorenz, Guillermina Pacini, María R. Repetti, Luisina D. Demonte, Jorgelina Varayoud, Enrique H. Luque
    Archives of Toxicology.2018; 92(8): 2629.     CrossRef
A Trial for Association between Oxidative Stress in Midterm Pregnancy and Postnatal Growth during the First Year of Life.
Hyesook Park, Young Ju Kim, Hwa Young Lee, Eun Ae Park, Nam Soo Chang, Eun Hee Ha, Bo Hyun Park, Bo Eun Lee, Ju Hee Hong
Korean J Epidemiol. 2004;26(1):17-26.
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AbstractAbstract PDF
Abstract
OBJECTIVES
We aims to construct Infant Growth Cohort for evaluating whether oxidative stress in midterm pregnancy has an adverse effect on postnatal growth.
METHODS
AND MATERIALS: From September 2001 to April 2004, we constructed an Ewha Infant Growth Cohort connected with the Ewha Pregnant Women Cohort. We excluded mother-and-child pairs in which the mother had experienced hypertension or diabetes during pregnancy and had multiple births for this study, which gave us 233 mother-and-child pairs for analysis. We measured maternal serum homocysteine and urinary 8-hydroxyguanosine (8-OHdG) and malondialdehyde (MDA) at 24~28 weeks of pregnancy, and infant weights at birth and at 6 and 12 months postnatally. We applied repeated measures ANOVA with PROC MIXED to assess the significance of differences.
RESULTS
We followed 64 and 85 infants at 6 and 12 months respectively. The mean body weights were 3146.4 g at birth, 8229.7 g at 6 months, and 1006.47 g at 12 months. The mean birth weight of infants was lower in mothers with higher homocysteine levels (third and fourth quartiles), but body weights from the first- and fourth-quartile groups of maternal homocysteine levels were lower than the others even though it was not statistically significant. Body weights at birth and at 6 months in third- and fourth-quartile groups of 8-OHdG levels were lower than the others. The body weights in the fourth quartile MDA group were significantly lower than the others at all time points.
CONCLUSIONS
Maternal oxidative stress in midterm pregnancy may cause postnatal growth retardation. But, there were high rate of follow up loss and various measurement errors. Therefore, we need to have efforts for compete follow up and valid and reliable measurements.
Summary
Epidemiologic Study for the Association between Phenol Contaminated Drinking Water and Poor Pregnancy Outcomes in Taegu City.
Jung Han Park, Ju Young Lee
Korean J Epidemiol. 2000;22(1):20-31.
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AbstractAbstract PDF
Abstract
From 14 to 17 March 1991 the Nakdong River which is a major source of drinking water for Taegu was contaminated with phenol that was spilled out of a factory in Gumi industrial park. Many people who drank the contaminated water complained of various symptoms and were apprehensive of possible adverse effect to the fetus. This study was conducted to examine the effect of drinking water contaminated with phenol on pregnancy outcome in Taegu. All of livebirths and stillbriths delivered in the 5 General Hospitals in Taegu during 1 year from 1 April 1991 were included for this study. For this duration, total number of babies delivered in the 5 General Hospitals was 21,196. Among them, 77.7%(16,468) were delivered from women living in Taegu and it accounted for 47.5% of 34,688 livbirths registered in Taegu during the same period. The babies born to the women living in Taegu were divided into phenol-exposed and unexposed groups. Exposed group was the residents of the area where contaminated water was supplied and they accounted for 81.4% of the women included for this study. Unexposed group was the residents of the area where drinking water was not contaminated with phenol and they accounted for 18.6% of the study subjects. Data were abstracted from the hospital records. All the rates were adjusted for the maternal age and parity by direct method. The abortion rates for the exposed group was 1.7 per 1,000 abortions and livebirths and 1.6 for the unexposed group. The stillbirth rate for the exposed group was 10.5 per 1,000 livebirths and stillbirths 20 weeks of gestation and 9.5 for unexposed group. The early neonatal death rate(within the 1st week after birth) for the exposed group was 7.8 per 1,000 livebirths and 5.4 for the unexposed group. The perinatal death rate for the exposed group was higher as 14.1 per 1,000 livebirths and stillbirths 28 weeks of gestation than 10.8 for the unexposed group. The proportions of intrauterine growth retardation(IUGR) were 2.7% for the exposed group and 3.3% for the unexposed group. Congenital anomaly incidence rates per 1,000 livebirths was 7.4 for the exposed group and 8.4 for the unexposed group. The low birthweight incidence rate for the exposed group was 6.6% and 6.5% for the unexposed group. These differences between two groups were not statistically significant. The premature birth rate(< 37 completed gestational week) was 6.0% for the exposed group and 4.8% for the unexposed group and the difference was statistically significant(p<0.05). Monthly variation of these indices did not show any clue that suggested concurrent change with the phenol contamination of the drinking water. There were no sufficient evidence that could support the hypothesis of adverse effects of phenol contaminated water on pregnancy outcome, such as abortion, stillbirth, premature birth, IUGR, congenital anomalies and early neonatal death.
Summary
Reproductive Factors Related to Serum Estrogen, Progesterone, and Sex Hormone Binding Globulin in Postmenopausal Women in Korea.
Chul Hwan Kim, Sue Kyung Park, Heon Kim, Mi Na Ha, Hai Rim Shin, Bu Ok Lee, Dae Sung Kim, Dae Hee Kang, Keun Young Yoo
Korean J Epidemiol. 1998;20(1):70-81.
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AbstractAbstract PDF
Abstract
The etiology of breast cancer is not yet clear. Several epidemiologic studies have supported the concepts that endogenous female sex hormones, i.e., estrogen and progesterone, may play a central role in the development of breast cancer. Female reproductive factors such as menstruation, pregnancy, and breast feeding are well-known risk factors of breast cancer. There have been many suggestions that all these factors are midiated by female sex hormeones. However, only a few studies have evaluated the relationship between the reproductive factors and endogenous female sex hormones. This study was designed to evaluate the relationship between the reproductive factors and endogenous female sex hormones in Korean women. We analyzed the relationship between reproductive factors and female sex hormones in 153 premenopausal women 153 postmenopausal women who participated in a community health promotion program in Haman County, Korea. The questionnaires about reproductive factors were completed by personal interview. Serum level of total estradiol(E2), progesterone(:g), and sex hormone binding globulin(SHBG) were measured by radioimmunoassay. There was no significant correlation between age at menarche and E2 in both premenopausal and postmenopausal groups. In postmenopausal subjects, E2 level increased significantly with the age at menopause increasing(r=0.25, p=0.009), adjusting for the potential confounding effect of both age and body mass index. There was a positive correlation between E2 and the intervals between age at menarche and age at menopause(r=0.25, p=0.009). Moreover, the serum level of SHBG was significantly correlated with total months of breast feeding(r=0.19, p=0.048), as well as with age at first fullterm pregnancy(r=-0.24, p=0.01). However, Pg was correlated with none of reproductive factors in both groups. This study observed that female reproductive factors, e.g., age at menopause, breast feeding, age at first fullterm pregnancy, were correlated with serum female hormones, particularly E2 and SHBG. The results provide an evidence that the relationship between the reproductive factors and breast cancer risk may be mediated, at least in part, through serum female hormones, especially estradiol in Korean women.
Summary
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