Association of gestational weight gain and pre-pregnancy body mass index with adverse pregnancy outcome

Objective: To determine the association between gestation weight gain (GWG) and adverse pregnancy outcome in a Pakistani population.Study Design: Analytical study.Place and Duration of Study: The Aga Khan University, Karachi, from February 2003 to 2007.Methodology: This study used secondary data of 4,735 women from a large cohort study on fetal growth. Pre-pregnancy BMI was categorized according to the recommendations from the institute of medicine (IOM, 2009) and gestation weight gain (GWG) was noted. Chi-square test was used to find the association of GWG and pre-pregnancy BMI with low birth weight (LBW), preterm delivery, large for gestational age (LGA), and caesarean section. Logistic regression analysis was performed to control for confounders like age, parity, working status and ethnicity.Results: The prevalence of LBW decreased with increasing BMI. GWG of the population was noted as 8.5 kg. LBW was observed to have an inverse relationship with GWG. Women below the age of 19 were twice more likely to have LBW than above 35 years of age. Weight gain above the recommended range were twice more likely to have large for dates. Overweight women were 1.5 times more likely to deliver preterm whereas obese women were 1.4 times more likely to undergo caesarean section than women with normal BMI.Conclusion: The optimal weight gain was estimated to be 8.5 kg to prevent low birth weight in our population. Obese women are more likely to have LGA, caesarean sections and pre-term deliverie

Improving women’s access to continuum of maternity-care services: A maternity-care model for rural Sindh, Pakistan

&nbsp;The study explored factors associated with lack of utilization of skilled maternity care and reproductive health services of rural women who lives in remote and flood-prone regions of Pakistan. The study proposes a parsimonious maternity care model which offers optimal utilization of existing health workforce and infrastructure to ensure continuum of maternity care services to women and girls in rural Pakistan.<br /

Rural women\u27s experience of living and giving birth in relief camps in Pakistan

Background: Women are more vulnerable than men in the same natural disaster setting. Preexisting gender inequality, socio-cultural community dynamics and poverty puts women at significant risk of mortality. Pregnant women are particularly vulnerable because of their limited or no access to prenatal and obstetric care during any disaster or humanitarian emergency setting.Methods: In-depth interviews were conducted with 15 women who gave birth during the 2011 floods in Sindh Province, Pakistan. Thematic analysis explored women&rsquo;s experiences of pregnancy and giving birth in natural disaster settings, the challenges they faced at this time and strategies they employed to cope with them. Results: Women were not afforded any control over decisions about their health and safety during the floods. Decisions about the family&rsquo;s relocation prior to and during the floods were made by male kin and women made no contribution to that decision making process. There were no skilled birth attendants, ambulances, birthing or breastfeeding stations and postnatal care for women in the relief camps. Women sought the assistance of the traditional birth attendants when they gave birth in unhygienic conditions in the camps.Conclusion: The absence of skilled birth attendants and a clean physical space for childbirth put women and their newborn infants at risk of mortality. A clean physical space or birthing station with essential obstetric supplies managed by skilled birth attendants or community health workers can significantly reduce the risks of maternal morbidity and mortality in crisis situations

Short-term neonatal outcome in late preterm vs. term infants

Objective: To determine the short-term neonatal outcomes in late preterm infants (LPI\u27s) as compared to term infants and their association with maternal risk factors. Study Design: A case control, descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, Pakistan, from January to December 2009. Methodology: The study included 326 late preterm babies (defined as those born between 340 ⁄7 to 376 ⁄7 weeks of gestation) and equal number of term control babies at the Aga Khan University Hospital, Karachi, Pakistan. Data, including obstetric history, maternal complications, neonatal morbidities, etc., was retrieved from patients\u27 medical records. The data was compared with the control group for complications, fetal morbidity and maternal morbidity. Results: Late preterm infants constituted 10.6% of all deliveries and 77% of all live preterm births during the study period. Respiratory distress syndrome (RDS) (16.5% vs. 0.3%, p \u3c 0.001), growth retardation (24.8% vs. 4%, p \u3c 0.001), hyperbilirubinemia requiring phototherapy (37.9% vs. 11%, p \u3c 0.001), and sepsis (4.9% vs. 0.3%, p \u3c 0.001) were found to be the major morbidities in the study group. The need for resuscitation was 12.7 times higher in the study group as compared to the term babies (21.4% vs. 1.2%, p \u3c 0.001). NICU admissions in the study group were also higher (18.8% vs. 2.4%, p \u3c 0.001). Hypertension (12.5% vs. 1.5%, p \u3c 0.001), diabetes (12.5% vs. 9.2%, p \u3c 0.001), antenatal history of UTI (1.5% vs. 0.3%, p \u3c 0.001), and prolong rupture of membrane (8.9% vs. 4%, p \u3c 0.001) were significant maternal morbidities in the late preterm group. Conclusion: The late preterm group had greater morbidity, compared to term neonates. Prior awareness of the morbidities associated with late preterm babies is helpful for the health care providers to anticipate and manage potential complications in late preterm infants

Suicide in first-generation Australian migrants, 2006–2019: a retrospective mortality studyResearch in context

Summary: Background: This study addressed the limited understanding of suicide risk and patterns among migrants in Australia. It examined national-level suicide rates and trends in the Australian population to identify migrant groups which are disproportionately affected by suicide. Methods: The National Coronial Information System was used to identify suicide cases from 2006 to 2019. Incident rate ratios (IRR) with 95% confidence intervals (CI) evaluated suicide risk for migrant groups compared to Australian-born and migrants from English-speaking countries. Age-standardised suicide rates (ASR) per 100,000 and average annual percentage change (AAPC) were calculated to compare suicide rates and trends. Findings: Compared to the Australian-born population, all migrant males and females had significantly lower suicide risk, except females from Oceania countries. Females from European (IRR 1.28, 95% CI 1.13, 1.14) and Oceanian countries (IRR 1.25; 95% CI 0.95, 1.66) had an elevated suicide risk compared to female migrants from English-speaking countries. Male migrants from Oceania (ASR 20.4, AAPC 1.0 (−3.6, 5.8)) and Africa (ASR 18.0, AAPC −0.4 (−5.5, 4.9)) have high ASR with no significant changes in trend over the study duration. Female African migrants had an ASR of 5.3 per 100,000, which increased by 8% (95% CI 1.4, 15.0) between 2006 and 2019. Interpretation: Migrants from Oceania and African countries are disproportionately affected by suicide mortality compared to other migrant groups in Australia. Further research is needed to identify the risk factors and develop suicide prevention strategies for these groups. Funding: Suicide Prevention Australia, Australian Research Council

Perinatal outcome of twin pregnancies according to chorionicity: an observational study from tertiary care hospital

Objective: To assess the perinatal outcome in twin pregnancies according to chorionicity. Methods: This was a retrospective cohort study of twin pregnancies from January 2001 to December 2012. Maternal and perinatal outcomes of monochorionic (MC) and dichorionic (DC) twins were compared by using chi-square and t-test. Perinatal complications were compared by adjusted odds ratio using logistic regression at 5% level of significance. Results: Among 391 twin pregnancies, 116 (29.6%) were MC and 275 (72.95%) were DC. In MC twins, the rate of miscarriage was three fold higher than DC (12.6% versus 4.4%; p-value \u3c 0.000). Mean birth weight in DC was 218.4 g higher than the MC (p value \u3c 0.000). Similarly, MC twins were 1.92 times [CI (1.02–3.62), p value = 0.042] more likely to be delivered preterm. Likewise, neonatal intensive care admission for MC was 2.23 times [CI (1.08–4.06), p-value = 0.03], congenital anomalies were 4.75 times [CI (1.22–18.4), p value = 0.024]. Fetal growth restriction was 1.86 times more common in the MC twin pair [CI (1.07–3.21), p-value = 0.026]. Conclusions: MC twins were more at risk for adverse outcomes than DC twins. Determining chorionicity at early pregnancy will help the Obstetricians to plan the care of these patients. This will help not only in managing twin pregnancies but also help in counseling according to the local perinatal outcome