Effect of uncomplicated chronic hypertension on the risk of small-for- gestational age birth

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Santé globale: une santé publique mondialisée. Editorial

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Pregnancy-related deaths in four regions of Europe and the United States in 1999-2000: Characterisation of unreported deaths

Objective: We compared official maternal mortality statistics with those from a special study covering all pregnancy-associated deaths in two European countries (Finland and France) and in two US states (Massachusetts and North Carolina) in 1999-2000 to characterize pregnancy-related deaths that are not included in official statistics. Study design: We linked the official ICD-10-based maternal mortality data for 84 deaths with study data on 404 pregnancy-associated deaths. Results: Of the pregnancy-associated deaths, 151 were pregnancy-related. We found 69 pregnancy-related deaths that had not been included as maternal deaths, and two deaths coded as maternal deaths that did not meet our definition for a pregnancy-related death. In total, 58 of these 69 deaths were from medical causes and 11 were from external causes or injuries (10 postpartum depression-related suicides and one accidental drug poisoning). The unreported deaths due to medical causes included 27 direct, 15 indirect, and two direct/indirect pregnancy-related deaths and 14 possibly pregnancy-related deaths. The most common causes of the unreported deaths due to medical causes were intracerebral hemorrhage (7 deaths), peripartum cardiomyopathy (4), pulmonary embolism (4) and pregnancy-induced hypertension (4). Conclusions: The collection of data on pregnancy-related and pregnancy-associated deaths is useful for countries with low maternal mortality figures. The use of various data-collection methods may substantially increase the quality of maternal mortality statistics. © 2006 Elsevier Ireland Ltd. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Symptomatic Dengue Infection during Pregnancy and Infant Outcomes: A Retrospective Cohort Study

<div><p>Background</p><p>Dengue is a mosquito-borne disease that is common in many tropical and subtropical areas. Dengue infections can occur at any age and time in the lifespan, including during pregnancy. Few large scale studies have been conducted to determine the risk of preterm birth (PTB) and low birthweight (LBW) for infants born to women who had symptomatic dengue infection during pregnancy.</p><p>Methodology/Principal Findings</p><p>This study is a retrospective cohort study using medical records from 1992–2010 from pregnant women who attended a public regional referral hospital in western French Guiana. Exposed pregnancies were those with laboratory confirmed cases of dengue fever during pregnancy. Each of the 86 exposed infants was matched to the three unexposed births that immediately followed them to form a stratum. Conditional logistic regression was used to analyze these matched strata. Three groups were examined: all infants regardless of gestational age, only infants> = 17 weeks of gestational age and their strata, and only infants> = 22 weeks of age and their strata. Odds ratios were adjusted (aOR) for maternal age, maternal ethnicity, maternal gravidity, interpregnancy interval and maternal anemia. There was an increased risk of PTB among women with symptomatic dengue; (aOR all infants: 3.34 (1.13, 9.89), aOR 17 weeks: 1.89 (0.61, 5.87), aOR 22 weeks: 1.41 (0.39, 5.20)) but this risk was only statistically significant when all infants were examined (p value = 0.03). Adjusted results for LBW were similar, with an increased risk in the exposed group (aOR All infants: 2.23 (1.01, 4.90), aOR 17 weeks: 1.67 (0.71, 3.93), aOR 22 weeks: 1.43 (0.56, 3.70)) which was only statistically significant when all infants were examined (p value = 0.05).</p><p>Conclusions/Significance</p><p>Symptomatic dengue infection during pregnancy may increase the risk of PTB and LBW for infants. More research is needed to confirm these results and to examine the role of dengue fever in miscarriage.</p></div

Dengue epidemics and adverse obstetrical outcomes in French Guiana: a semi-ecological study.: Dengue and adverse obstetrical outcomes

International audienceOBJECTIVE: To determine whether dengue epidemics are associated with an increase in adverse obstetrical outcomes. METHODS: Semi-ecological study combining individual data on obstetrical events from the perinatal registry and aggregated exposure data from the epidemiologic surveillance of dengue in Cayenne, French Guiana between 2004 and 2007. RESULTS: After adjustment for individual risk factors, analysis showed that an epidemic level of dengue transmission during the first trimester was associated with an increased risk of post-partum haemorrhage and preterm birth. The associated risks seemed to depend on the epidemic level. CONCLUSIONS: Despite its limitations, this study suggests that dengue in the first trimester may be related to preterm birth and to post-partum bleeding, thus leading to specific hypotheses that should be tested in prospective studies

Maternal demographic characteristics among the study population.

<p>Exposed: fetuses or infants whose mothers had confirmed symptomatic dengue infection during pregnancy.</p><p>Unexposed: fetuses or infants whose mothers did not have confirmed symptomatic dengue infection during pregnancy.</p><p>Maternal demographic characteristics among the study population.</p

Poor birth outcomes among study infants, stratified by maternal dengue fever.

<p>Exposed: fetuses or infants whose mothers had confirmed symptomatic dengue infection during pregnancy.</p><p>Unexposed: fetuses or infants whose mothers did not have confirmed symptomatic dengue infection during pregnancy.</p><p>*Only considering dengue cases before 37 weeks of gestation.</p><p>Poor birth outcomes among study infants, stratified by maternal dengue fever.</p

Characteristics of symptomatic maternal and infant dengue infections.

<p>*Trimesters are defined as: 1st ≤14 weeks of gestational age, 2nd 15–28 weeks of gestational age, 3rd trimester≥29 weeks of gestational age.</p><p>Characteristics of symptomatic maternal and infant dengue infections.</p

Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules

BACKGROUND: Clinical decision rules (CDRs) could be helpful to safely distinguish between bacterial and aseptic meningitis (AM). OBJECTIVE: To compare the performance of two of these CDRs for children: the Bacterial Meningitis Score (BMS) and the Meningitest. DESIGN: Secondary analysis of retrospective multicentre hospital-based cohort study. SETTING: Six paediatric emergency or intensive care units of tertiary care centres in five European countries. PATIENTS: Consecutive children aged 29 days to 18 years presenting with acute meningitis and procalcitonin (PCT) measurement. Intervention None. MAIN OUTCOME MEASURES: The sensitivity and specificity of the BMS (start antibiotics in case of seizure, positive cerebrospinal fluid (CSF) Gram staining, blood neutrophil count >/=10 x10(9)/l, CSF protein level >/=80 mg/dl or CSF neutrophil count >/=1000 x10(6)/l) and the Meningitest (start antibiotics in case of seizure, purpura, toxic appearance, PCT level >/=0.5 ng/ml, positive CSF Gram staining or CSF protein level >/=50 mg/dl) were compared using a McNemar test. RESULTS: 198 patients (mean age 4.8 years) from six centres in five European countries were included; 96 had bacterial meningitis. The BMS and Meningitest both showed 100% sensitivity (95% CI 96% to 100%). The BMS had a significantly higher specificity (52%, 95% CI 42% to 62% vs 36%, 95% CI 27% to 46%; p<10(-)8). CONCLUSION: The Meningitest and the BMS were both 100% sensitive. This result provides level II evidence for the sensitivity of both rules, which can be used cautiously. However, use of the BMS could safely avoid significantly more unnecessary antibiotic treatments for children with AM than can the Meningitest in this population