3 research outputs found
Factors associated with ultrasound-aided detection of suboptimal fetal growth in a malaria-endemic area in Papua New Guinea
BACKGROUND: Fetal growth restriction (FGR) is associated with
increased infant mortality rates and ill-health in adulthood.
Evaluation of fetal growth requires ultrasound. As a result,
ultrasound-assisted evaluations of causes of FGR in
malaria-endemic developing countries are rare. We aimed to
determine factors associated with indicators of abnormal fetal
growth in rural lowland Papua New Guinea (PNG). METHODS: Weights
and growth of 671 ultrasound-dated singleton pregnancies (<25
gestational weeks) were prospectively monitored using estimated
fetal weights and birthweights. Maternal nutritional status and
haemoglobin levels were assessed at enrolment, and participants
were screened for malaria on several occasions. FGR was
suspected upon detection of an estimated fetal weight or
birthweight <10(th) centile (small-for-gestational age)
and/or low fetal weight gain, defined as a change in weight
z-score in the first quartile. Factors associated with fetal
weight and fetal weight gain were additionally assessed by
evaluating differences in weight z-scores and change in weight
z-scores. Log-binomial and linear mixed effect models were used
to determine factors associated with indicators of FGR. RESULTS:
SGA and low weight gain were detected in 48.3% and 37.0% of
pregnancies, respectively. Of participants, 13.8%, 21.2%, and
22.8% had a low mid-upper arm circumference (MUAC, <22 cms),
short stature (<150 cms) and anaemia (haemoglobin <90 g/L)
at first antenatal visit. 24.0% (161/671) of women had at least
one malaria infection detected in peripheral blood. A low MUAC
(adjusted risk ratio [aRR] 1.51, 95% CI 1.29, 1.76, P <
0.001), short stature (aRR 1.27, 95% CI 1.04, 1.55, P = 0.009),
and anaemia (aRR 1.27, 95% CI 1.06, 1.51, P = 0.009) were
associated with SGA, and a low body mass index was associated
with low fetal weight gain (aRR 2.10, 95% CI 1.62, 2.71, P <
0.001). Additionally, recent receipt of intermittent preventive
treatment in pregnancy was associated with increased weight
z-scores, and anaemia with reduced change in weight z-scores.
Malaria infection was associated with SGA on crude but not
adjusted analyses (aRR 1.13, 95% CI 0.95, 1.34, P = 0.172).
CONCLUSION: Macronutrient undernutrition and anaemia increased
the risk of FGR. Antenatal nutritional interventions and malaria
prevention could improve fetal growth in PNG
Determining effects of areca (betel) nut chewing in a prospective cohort of pregnant women in Madang Province, Papua New Guinea
BACKGROUND: Chewing areca nut (AN), also known as betel nut, is
common in Asia and the South Pacific and the habit has been
linked to a number of serious health problems including oral
cancer. Use of AN in pregnancy has been associated with a
reduction in mean birthweight in some studies, but this
association and the relationship between AN chewing and other
adverse pregnancy outcomes remain poorly understood. METHODS: We
assessed the impact of AN chewing on adverse outcomes including
stillbirth, low birthweight (LBW, <2,500 g) and anaemia at
delivery (haemoglobin <11.0 g/dL) in a longitudinal cohort of
2,700 pregnant women residing in rural lowland Papua New Guinea
(PNG) from November 2009 until February 2013. Chewing habits and
participant characteristics were evaluated at first antenatal
visit and women were followed until delivery. RESULTS: 83.3%
[2249/2700] of pregnant women used AN, and most chewed on a
daily basis (86.2% [1939/2249]. Smoking and alcohol use was
reported by 18.9% (511/2700) and 5.0% (135/2688) of women,
respectively. AN use was not associated with pregnancy loss or
congenital abnormalities amongst women with a known pregnancy
outcome (n = 2215). Analysis of 1769 birthweights did not
demonstrate an association between AN and LBW (chewers: 13.7%
[200/1459] vs. non-chewers: 14.5% [45/310], P = 0.87) or reduced
mean birthweight (2957 g vs. 2966 g; P = 0.76). Women using AN
were more likely to be anaemic (haemoglobin <11 g/dL) at
delivery (75.2% [998/1314] vs. 63.9% [182/285], adjusted odds
ratio [95% CI]: 1.67 [1.27, 2.20], P < 0.001). Chewers more
commonly had male babies than non-chewers (46.1% [670/1455] vs.
39.8% [123/309], P = 0.045). CONCLUSIONS: AN chewing may
contribute to anaemia. Although not associated with other
adverse pregnancy outcome in this cohort gestational AN use
should be discouraged, given the potential adverse effects on
haemoglobin and well-established long-term health risk including
oral cancer. Future research evaluating the potential
association of AN use and anaemia may be warranted. TRIAL
REGISTRATION: ClinicalTrials.gov NCT01136850 (06 April 2010)
Determining effects of areca (betel) nut chewing in a prospective cohort of pregnant women in Madang Province, Papua New Guinea
BACKGROUND: Chewing areca nut (AN), also known as betel nut, is
common in Asia and the South Pacific and the habit has been
linked to a number of serious health problems including oral
cancer. Use of AN in pregnancy has been associated with a
reduction in mean birthweight in some studies, but this
association and the relationship between AN chewing and other
adverse pregnancy outcomes remain poorly understood. METHODS: We
assessed the impact of AN chewing on adverse outcomes including
stillbirth, low birthweight (LBW, <2,500 g) and anaemia at
delivery (haemoglobin <11.0 g/dL) in a longitudinal cohort of
2,700 pregnant women residing in rural lowland Papua New Guinea
(PNG) from November 2009 until February 2013. Chewing habits and
participant characteristics were evaluated at first antenatal
visit and women were followed until delivery. RESULTS: 83.3%
[2249/2700] of pregnant women used AN, and most chewed on a
daily basis (86.2% [1939/2249]. Smoking and alcohol use was
reported by 18.9% (511/2700) and 5.0% (135/2688) of women,
respectively. AN use was not associated with pregnancy loss or
congenital abnormalities amongst women with a known pregnancy
outcome (n = 2215). Analysis of 1769 birthweights did not
demonstrate an association between AN and LBW (chewers: 13.7%
[200/1459] vs. non-chewers: 14.5% [45/310], P = 0.87) or reduced
mean birthweight (2957 g vs. 2966 g; P = 0.76). Women using AN
were more likely to be anaemic (haemoglobin <11 g/dL) at
delivery (75.2% [998/1314] vs. 63.9% [182/285], adjusted odds
ratio [95% CI]: 1.67 [1.27, 2.20], P < 0.001). Chewers more
commonly had male babies than non-chewers (46.1% [670/1455] vs.
39.8% [123/309], P = 0.045). CONCLUSIONS: AN chewing may
contribute to anaemia. Although not associated with other
adverse pregnancy outcome in this cohort gestational AN use
should be discouraged, given the potential adverse effects on
haemoglobin and well-established long-term health risk including
oral cancer. Future research evaluating the potential
association of AN use and anaemia may be warranted. TRIAL
REGISTRATION: ClinicalTrials.gov NCT01136850 (06 April 2010)