Birth outcomes and associated risk factors of anaemia in early pregnancy in a nulliparous cohort

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Epidemiology & Biostatistics. Johannesburg, February 2015Background Anaemia in pregnancy is a major public health and economic problem worldwide, that contributes to both maternal and fetal morbidity and mortality. Clinical manifestations of anaemia in pregnancy include fetal growth restriction, preterm delivery, low birth weight, impaired lactation, poor maternal/infant behavioural interactions and post partum depression. Objective The aim of the study was to calculate the prevalence of anaemia in early pregnancy in a cohort of ‘low risk’ women participating in a large international multicentre prospective study (n = 5 609), to identify the modifiable risk factors for anaemia in pregnancy in this cohort, and to compare the birth outcomes between pregnancies with and without anaemia in early gestation. Methods The study is an analysis of data that were collected prospectively during the Screening for Pregnancy Endpoints (SCOPE) study. Anaemia was defined according to the World Health Organization’s definition of anaemia in pregnancy (haemoglobin < 11g/dL). Binary logistic regression with adjustment for potential confounders (country, maternal age, having a marital partner, ethnic origin, years of schooling, and having paid work) was the main method of analysis. Results The hallmark findings were the low prevalence of anaemia (2.2%), that having no marital partner was an independent risk factor for having anaemia (OR 1.34, 95% CI 1.01-1.78), and that there was no statistically significant effect of anaemia on adverse pregnancy outcomes (small for gestational age, pre-tem birth, mode of delivery, low birth weight, APGAR score < 7 at one and five minutes). Adverse pregnancy outcomes were however more common in those with anaemia than in those without. Conclusion The absence of a marital partner is an important non-modifiable factor that should be added to the conceptual framework of anaemia’s determinants. Although not statistically significant, clinically, a trend towards a higher risk of adverse pregnancy outcomes was observed in women that were anaemic in early pregnancy

Food for thought : palatable eponyms from Pediatrics

Food-related medical terms are frequently used in the field of pediatrics for the definition, recognition and diagnosis of disease. Almost 40 food-related medical eponyms used in Pediatrics have been ‘cherry picked’ and described by the authors. Two of these terms have been illustrated. Culinary medical analogies allow healthcare providers to easily interpret the variety of sensations experienced during medical decision-making, providing a better taste for interpreting pathology discovered on physical exam. Despite some misgivings, food-related medical terms make medical education more appetizing and allow for rapid diagnosis of classic presentations.peer-reviewe

Caesarean section delivery and childhood obesity

Background and aims: Caesarean section (CS) birth, in particular elective/planned CS, has been found to be associated with an increased risk of childhood obesity. Various mechanisms that differ by birth mode, including differences in the vaginal and faecal microflora and stress hormone concentration have been suggested to underpin this association. The literature describing this association, often derived from non-nationally representative cohorts has been inconsistent, limited by small sample size, often unable to distinguish between elective and emergency CS, have publication bias favouring positive effects and often unable to adjust for key confounders like maternal pre-pregnancy body mass index (BMI). Given the rising global use of CS with some countries having CS rates above 50%, the aim of this thesis was to critically evaluate the association between CS birth and childhood obesity and to use three large contemporary nationally representative prospective longitudinal cohort studies and one smaller cohort, with detailed phenotypic data, to investigate this association. Structure and methods: The existing published literature relating to CS birth and childhood obesity was critically evaluated and synthesised to identify major conceptual themes and research gaps (Chapter 1). Chapter 2 details and justifies the thesis’ methodological approach. The following four longitudinal birth cohort studies were utilised: Screening for Pregnancy Endpoints (SCOPE) and Babies After SCOPE: Evaluating the Longitudinal Impact on Neurological and Nutritional Endpoints (BASELINE); Growing Up in Ireland (GUI); Growing Up in New Zealand (GUiNZ) and the Millennium Cohort Study (MCS) cohorts. In order to facilitate comparison between different cohorts (Chapters 3 through to 7), children were classified, on the basis of their BMI, as obese, overweight, normal or underweight according to the sex and age specific International Obesity Task Force criteria. A range of statistical analytic approaches including linear, multinomial and mixed-effects regression were employed. Multiple imputation was used to handle substantial missing data. In addition to our primary outcome BMI, which was modeled as continuous or categorical variable, the association between our exposure CS birth and BF% was investigated in cohorts that had this data available. Where the sample size permitted, the association between CS birth and transition into or out of obesity was examined. The overall results in the context of the published literature were discussed including limitations and strengths and future research directions (Chapter 7). Results: SCOPE-BASELINE cohorts: At two months of age, children born by CS, had a similar BF% to those born vaginally. At age six months, children born by CS had a significantly higher BMI, adjusted mean difference=0.24; 95% confidence interval (CI) 0.06 to 0.41, but this did not persist into future childhood, at age five years. There was no evidence to support an association between mode of delivery and long-term risk of obesity in the child. GUI cohort: We found insufficient evidence to support a relationship between elective CS and childhood obesity at age three and five years. An increased risk of obesity in children born by emergency CS, adjusted relative risk ratio (aRRR) = 1.56; [95% CI 1.20 to 2.03], but not elective, suggests that the influence of vaginal microflora in developing childhood obesity was minimal. The association with emergency CS was likely due to its indications. GUiNZ cohort: Planned CS was an independent predictor of obesity in early childhood at age two years aRRR=1.59; [95% CI 1.09 to 2.33] but this association was not apparent by four and a half years This suggests that birth mode is associated with early growth, at least in the short term. This association occurred during a critical phase of human development, the first two years of life. Given the developmental origins of health and disease hypothesis this may lead to long-term detrimental cardiometabolic changes. MCS cohort: Infants born by planned CS did not have a significantly higher BMI at ages three, five, seven, eleven and fourteen years adjusted mean difference=0.00; [95% CI -0.10 to 0.10], or BF% at ages seven 0.13; [95% CI -0.23; 0.49] and fourteen compared to those born by normal VD. This may suggest that the association, described in the literature, could be due to the indications/reasons for CS birth or residual confounding. Conclusions: The hallmark finding of the thesis was an association between CS birth in general, elective CS in particular, and childhood obesity during the first two years of life. This association had dissipated by age three through to fourteen. Whether this association remerges in adulthood or is a risk factor for cardiometabolic disease is an area for future research. The association observed with emergency CS is possibly due to confounding by the underlying reasons for CS, confounding by indication. There is potential to improve consistency and robustness in this research field by better and standardised definition particularly of the exposure, CS birth. Better consistency in the timing of obesity assessment is also warranted

The most influential medical journals according to Wikipedia: Quantitative analysis

Wikipedia, the multilingual encyclopedia, was founded in 2001 and is the world’s largest and most visited online general reference website. It is widely used by health care professionals and students. The inclusion of journal articles in Wikipedia is of scholarly interest, but the time taken for a journal article to be included in Wikipedia, from the moment of its publication to its incorporation into Wikipedia, is unclear

The terrorist attacks and the human live birth sex ratio: a systematic review and meta-analysis.

The live birth sex ratio is defined as male/total births (M/F). Terrorist attacks have been associated with a transient decline in M/F 3-5 months later with an excess of male losses in ongoing pregnancies. The early 21st century is replete with religious/politically instigated attacks. This study estimated the pooled effect size between exposure to attacks and M/F. Registration number CRD42016041220. PubMed and Scopus were searched for ecological studies that evaluated the relationship between terrorist attacks from 1/1/2000 to 16/6/2016 and M/F. An overall pooled odds ratio (OR) for the main outcome was generated using the generic inverse variance method. Five studies were included: 2011 Norway attacks; 2012 Sandy Hook Elementary School shooting; 2001 September 11 attacks; 2004 Madrid and 2005 London bombings. OR at 0.97 95% CI (0.94-1.00) (I2 = 63%) showed a small statistically significant 3% decline in the odds (p = 0.03) of having a male live birth 3-5 months later. For lone wolf attacks there was a 10% reduction, OR 0.90 95% CI (0.86-0.95) (p = 0.0001). Terrorist (especially lone wolf) attacks were significantly associated with reduced odds of having a live male birth. Pregnancy loss remains an important Public Health challenge. Systematic reviews and meta-analyses considering other calamities are warranted

Evolution of wikipedia’s medical content: past, present and future

As one of the most commonly read online sources of medical information, Wikipedia is an influential public health platform. Its medical content, community, collaborations and challenges have been evolving since its creation in 2001, and engagement by the medical community is vital for ensuring its accuracy and completeness. Both the encyclopaedia’s internal metrics as well as external assessments of its quality indicate that its articles are highly variable, but improving. Although content can be edited by anyone, medical articles are primarily written by a core group of medical professionals. Diverse collaborative ventures have enhanced medical article quality and reach, and opportunities for partnerships are more available than ever. Nevertheless, Wikipedia’s medical content and community still face significant challenges, and a socioecological model is used to structure specific recommendations. We propose that the medical community should prioritise the accuracy of biomedical information in the world’s most consulted encyclopaedia

Full-term abdominal extrauterine pregnancy complicated by post-operative ascites with successful outcome: a case report

INTRODUCTION: Advanced abdominal (extrauterine) pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult. CASE PRESENTATION: We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well. CONCLUSION: Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn