Vitamin D Status and its Association with Morbidity including Wasting and Opportunistic Illnesses in HIV-Infected Women in Tanzania.

Vitamin D has a potential role in preventing HIV-related complications, based on its extensive involvement in immune and metabolic function, including preventing osteoporosis and premature cardiovascular disease. However, this association has not been examined in large studies or in resource-limited settings. Vitamin D levels were assessed in 884 HIV-infected pregnant women at enrollment in a trial of multivitamin supplementation (excluding vitamin D) in Tanzania. Information on HIV related complications was recorded during follow-up (median, 70 months). Proportional hazards models and generalized estimating equations were used to assess the relationship of vitamin D status with these outcomes. Women with low vitamin D status (serum 25-hydroxyvitamin D<32 ng/mL) had 43% higher risk of reaching a body mass index (BMI) less than 18 kg/m(2) during the first 2 years of follow-up, compared to women with adequate vitamin D levels (hazard ratio [HR]: 1.43; 95% confidence intervals: [1.03-1.99]). The relationship between continuous vitamin D levels and risk of BMI less than 18 kg/m(2) during follow-up was inverse and linear (p=0.03). Women with low vitamin D levels had significantly higher incidence of acute upper respiratory infections (HR: 1.27 [1.04-1.54]) and thrush (HR: 2.74 [1.29-5.83]) diagnosed during the first 2 years of follow-up. Low vitamin D status was a significant risk factor for wasting and HIV-related complications such as thrush during follow-up in this prospective cohort in Tanzania. If these protective associations are confirmed in randomized trials, vitamin D supplementation could represent a simple and inexpensive method to improve health and quality of life of HIV-infected patients, particularly in resource-limited settings

Prevalence of exclusive breastfeeding and its determinants in first 6 months of life: A prospective study

Background: Exclusive breastfeeding for first 6 months of life is recommended under Infant and Young Child Feeding practices in India. The objective of present study was to estimate the prevalence of exclusive breastfeeding during first 6 months of life of babies and to identify factors that interfere with the practice in the study area. Methods: A prospective cohort of 462 women who delivered at maternity unit of Government Medical College & Hospital, Rajkot, which is a tertiary care centre for the district, was studied. Data collection was done at hospital as well as during home visits of babies at 1, 3 and 6 months. Factors related to cessation of breastfeeding were analyzed using univariate, bivariate and multivariate analysis. Results: All 462 mothers reported breastfeeding their newborns. Prevalence of exclusive breastfeeding reported at 3 months was 97% which declined to 62% by 6 months of age of infants. Bivariate analysis revealed no significant association between interruption of exclusive breastfeeding before 6 months of age and various demographic, socioeconomic, maternal and infant characteristics. Multivariate analysis by logistic regression demonstrated no association between discontinuation of exclusive breastfeeding and socioeconomic status, maternal education and maternal age, number of antenatal visits, maternal employment and initiation of breastfeeding after delivery. Conclusion: Exclusive breastfeeding prevalence rate found higher than at national level indicating better feeding practices in these part of India. Also, factors classically considered as supportive for breastfeeding had shown no association with breastfeeding pattern in present study

Thrombocytopenia in Preterm Infants with Intrauterine Growth Restriction

Sick preterm infants often have thrombocytopenia at birth, and this is often associated with intrauterine growth restriction (IUGR), or birth weights less than the 10th percentile. The pathogenesis of the thrombocytopenia and its importance in IUGR are still unclear. We studied the characteristics of preterm IUGR infants with thrombocytopenia. Twenty-seven singleton Japanese preterm IUGR infants were born between January 2002 and June 2007 at Okayama University Hospital. Infants with malformation, chromosomal abnormalities, alloimmune thrombocytopenia, sepsis, and maternal aspirin ingestion were excluded. The infants were divided into group A (n&#65309;8), which had thrombocytopenia within 72h after birth, and group B (n&#65309;19), which did not. There were significant differences in birth weight, head circumference, umbilical artery (UA)-pulsatility index (PI), middle cerebral artery-PI, UA-pH, UA-pO2, and UA-pCO2. The infants in group A were smaller, had abnormal blood flow patterns, and were hypoxic at birth. We speculate that the infants with thrombocytopenia were more severely growth-restricted by chronic hypoxia. Thrombocytopenia is an important parameter for chronic hypoxia in the uterine.</p

Consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: A population-based case-control study

Introduction. Consanguineous marriage is associated with increased risks for congenital anomalies, low birthweight, and other adverse perinatal outcomes. In this population-based, case-control study we investigated the association between consanguineous marriage (first-cousin marriage) and stillbirth risk, using prospectively collected information from prepregnancy visits. Material and methods. From 2007 to 2009, we identified 283 stillbirths (cases) and 2088 randomly selected live control births through prepregnancy visits in rural Golestan, Iran. The associations between consanguinity and prepregnancy maternal characteristics and stillbirth risk were examined using multivariate logistic regression. Results. The rate of consanguineous marriage was 19.4% among cases and 13.6% among controls. Consanguinity was associated with increased stillbirth risk [odds ratio (OR) 1.53; 95% CI 1.10-2.14]. The association was significantly increased for preterm stillbirth (< 37 gestational weeks) (OR 2.43; 95% CI 1.46-4.04) but not for term stillbirth (≥ 37 weeks) (OR 1.14; 95% CI 0.75-1.74). Low and high maternal age, underweight, obesity, nulliparity, a history of infertility or miscarriage, previous obstetric complications (preeclampsia, preterm delivery, and stillbirth in previous pregnancies) were also associated with increased stillbirth risks. Conclusions. Consanguineous marriage is associated with increased risk of stillbirth, particularly preterm stillbirth. Findings for other maternal risk factors for stillbirth in rural Iran are consistent with previously reported findings from high-income countries. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology

Survey of reproduction and calf rearing in Asian and African elephants in European zoos

This document is a version of a published work that appeared in final form in Journal of Zoo and Aquarium Research. To access the final edited and published work see http://www.jzar.org/jzar/article/view/161.Acyclicity, conception failure, abortion, stillbirth, dystocia, infanticide and neonatal mortality have all been reported as causes of reproductive failure in zoo elephants. These events are often reported as single case reports or in specific studies focused on a particular stage in the reproductive process. In North America wider surveys of reproduction in the zoo elephant population have been completed and repeated to provide data over a number of years. This study is the largest and most comprehensive study of reproduction in the European zoo elephant population to date. Two questionnaires collected data from throughout the reproductive process from assessing cyclicity to independence of the calf at 5 years old. Information was collected regarding 189 birth events. Many causative and contributing factors such as obesity, infectious disease, husbandry, facilities, stress, behaviour, herd size and social grouping have been proposed. The importance of these was assessed and where possible association identified using statistical analysis. In African elephants, this study found that age, obesity, reproductive pathology and dominance, identified as important risk factors for failure to conceive in the American zoo elephant population were of low importance. The most significant cause in Europe was lack of access to a compatible bull. In Asian elephants reproductive failure was much less common but when it did occur age and reproductive pathologies were significant factors as found in previous studies. Previous studies have found that age, obesity and infanticide were considered as the most important risk factors in the period from birth to rearing. In this survey it was found that herd stability and compatibility, allomothering or maternal experience and management at parturition can significantly influence reproductive success. Elephant Endotheliotropic Herpes virus was confirmed as the biggest cause of calf mortality. This work provides evidence to support changes to elephant management in European zoos in order to encourage development of social and affiliative herd behaviours and improve reproductive success

Importance of Milk Expression for Preterm Infants

Mothers of preterm infants may find it difficult to express breast milk. There is a low breast milk rate among preterm infants at discharge at our hospital, and here we tested the hypothesis that milk expression factors were the cause of the low rate. The study subjects were born before 33 gestational weeks at our hospital between March 2005 and June 2014. Nutritional evaluation was performed at discharge and noted whether breast milk, infant formula, or a mix of the 2 was being given. We compared the group given breast milk or the mix versus the group given formula. Of the 337 infants, 40 cases were excluded. Data from 297 infants were analyzed. The mean (SD) gestational age and birth weight were 29.5 (2.4) weeks and 1,230 (391) g, respectively. At discharge, 26 (8.8%), 102 (33.3%), and 174 (57.9%) infants were given breast milk, formula, and the mix, respectively. A multivariate logistic regression analysis showed that the first milk expression (h) was the risk factor for the formula group: adjusted odds ratio (95% confidence interval) 1.06 (1.02-1.09) and p=0.002. Delayed first milk expression could affect the low breast milk rate at discharge. Improvement of milk expression should be achieved to promote breastfeeding