Predictors of adverse birth outcomes among pregnant adolescents in Ashanti Region, Ghana

Unraveling the complexity of selected adverse neonatal outcomes in India: a multilevel analysis using data from a nationally representative sample survey

INTRODUCTION

The burden of adverse neonatal outcomes (ANOs), encompassing preterm birth(PTB), low birth weight(LBW), and early neonatal deaths, remain significant public health challenge globally, particularly in developing countries. The study aims to provide estimates of adverse birth outcomes and examine their correlates by using a multi-level model analysis at individual/household/community level.

METHODOLOGY

The study has chosen three ANOs such as preterm birth(PTB), low birth weight(LBW), and early neonatal deaths (based on available data) for constructing a combined indicator which is calculated by the presence of any one of these variables. We used National-Family-Health-Survey India data(2019-21). Multilevel(three-level) logistic regression model was used to find the probability of binary adverse neonatal outcomes with the effects of individual/household/community level variables among the recently delivered women.

RESULT

Between 2019-21, a total of 26.5% ANOs were reported from 1.7 million pregnant women surveyed, a rate that has increased since 2005-06 (20%). Final multilevel model asserts that women having higher education [OR 0.92, 95%CI 0.88, 0.96), and those registered for antenatal checkups (OR 0.95, 95%CI OR 0.9, 0.99) and know all components of birth-preparedness-and-complication-readiness (OR 0.88, 95%CI 0.84, 0.92) have a higher protective odd of having adverse outcomes. Difficulty in seeking medical help (OR 1.2, 95%CI 1.15, 1.25) and belonging to poor wealth status and no intention to become pregnant (OR 1.11 95% CI 1.05, 1.18) acts as a risk factor. Multilevel model with household, community and district level variables added to the null model showed a decline in the ICC values to 4.7%, 18.8% and 30.9% respectively across district, community, and household levels.

CONCLUSION

The study underscores that specific ANOs in India has shown an increase, prompting significant concern. There is need to institute a mechanism for generating knowledge amongst women to protect them from unwanted pregnancies and later adverse outcomes.

Determinants of adverse birth outcomes among pregnant women in Kintampo municipal hospital, Ghana

Objective

To examine the predictors of adverse birth outcomes (ABOs) among pregnant women attending antenatal clinics at the Kintampo Municipal Hospital (KMH) in Ghana.

Method

A case-control study was conducted to enrol 408 pregnant women attending antenatal clinic at KMH into the study. Structured questionnaire was used to elicit information from the respondents. Stata version 15 was used to analyse the data. Multiple regression analysis was conducted to determine factors associated with ABOs. Level of statistical significance was established at p < 0.05.

Results

Factors that were significantly associated with ABOs were: receiving of ITN (aOR = 2.03, 95% CI: 1.20, 3.45), at least 8 times visits to ANC (aOR = 0.32, 95%CI: 0.15, 0.69), and partner's education (aOR = 0.53, 95%CI: 0.29, 0.96).

Conclusion

Contrary to expectations, this study revealed that receiving ITNs during pregnancy was associated with ABOs. Further research is needed to explain why receiving ITNs increases the likelihood of ABOs.

Unveiling the pathways: identifying the multifaceted determinants of low birth weight among neonates in low-income countries: a case-control study

Background

Low birth weight, as defined by the WHO, refers to the weight of a neonate below 2500 g at birth and is a significant public health concern globally, with both short- and long-term consequences. Despite the significance of low birth weight as a public health indicator, information gaps persist. Identifying at-risk mothers requires an understanding of the risk factors associated with low birth weight. Therefore, this study aimed to determine the common determinants of low birth weight among neonates born at public hospitals in Southern Ethiopia.

Methods

An unmatched case-control study was conducted among 258 neonates (86 cases and 172 controls) born at public hospitals between 15 April and 25 May 2022. The study participants were selected using a consecutive and systematic sampling technique. Data were analysed using Stata V.14, and a multivariable logistic regression model was performed. Statistical significance was declared at a p value<0.05.

Results

A total of 86 birth records of neonates with low birth weight and 172 birth records of neonates with normal birth weight were reviewed. The results revealed that lack of iron and folic acid supplementation (adjusted odds ratio (AOR) 2.47; 95% CI 1.16 to 5.25), lack of additional meal intake (AOR 2.66; 95% CI 1.16 to 6.00), anaemia (AOR 3.45; 95% CI 1.63 to 7.28), pregnancy-induced hypertension (AOR 2.49; 95% CI 1.04 to 5.97), mid-upper arm circumference (MUAC) (AOR 6.74; 95% CI 2.87 to 7.00), gestational age at first antenatal care (ANC) of ≥24 (AOR 7.31; 95% CI 3.43 to 15.58) and minimum food diversity (AOR 4.2; 95% CI 1.94 to 9.20) were common determinants of low birth weight.

Conclusion

Lack of iron and folic acid supplementation, additional meal intake, being anaemic, pregnancy-induced hypertension, gestational age at first ANC visit, MUAC ≤23 and minimum food diversity were common determinants of low birth weight. Initiating ANC services for all mothers and evaluating different risk factors may help to reduce low birth weight.

Exploring the Physical and Mental Health Challenges of Teenage Pregnancy: A Qualitative Study in the Tamale Metropolis, Ghana

Objective

Teenage pregnancy poses significant public health challenges globally, particularly affecting the physical and mental well-being of adolescent girls. Despite a global decline in teenage birth rates, regions like sub-Saharan Africa continue to experience high prevalence. In Ghana's Tamale metropolis, teenage pregnancy rates have shown a concerning rise, underscoring the need for an in-depth exploration of its multifaceted impacts. This study aims to explore the physical and mental health effects of teenage pregnancy in the Tamale metropolis, capturing their personal experiences and coping mechanisms.

Materials and methods

Employing a qualitative exploratory descriptive design, the study conducted a focus group discussion with 10 first-time teenage mothers aged 13-19 whose babies were less than 1 month. Participants were purposively sampled from antenatal records across five Community-based Health Planning and Services (CHPS) compounds. Discussions, guided by the socioecological model, were transcribed, translated, and thematically analyzed using NVivo software.

Results

Participants reported numerous physical health challenges, including severe nausea, vomiting, exhaustion, musculoskeletal pain, and infections like candidiasis. Mental health struggles encompass feelings of sadness, irritability, anxiety, and societal-induced stress. Coping strategies varied, with reliance on trusted individuals, avoidance of social situations, support from healthcare professionals, and family backing emerging as predominant themes.

Conclusion

This study revealed profound physical and mental health challenges compounded by societal stigma and limited resources. Strengthening social support networks, reducing stigma, and promoting patient-centered care are imperative. Targeted interventions are also essential to enhance health outcomes for these young mothers and their children.

Association between maternal dietary diversity during pregnancy and birth outcomes: evidence from a systematic review and meta-analysis

BACKGROUND

Maternal nutrition is a key factor influencing birth and offspring health outcomes in later life. Dietary diversity (DD) is a proxy for the macro/micronutrient adequacy of an individual's diet. There is inadequate comprehensive evidence regarding maternal nutrition during pregnancy, measured through DD and birth outcomes. This study aimed to provide extensive evidence on maternal DD during pregnancy and birth outcomes.

METHODS

A comprehensive search was performed using PubMed, HINARI, and Google Scholar databases up to January 17, 2024. Studies conducted among pregnant mothers and measuring maternal DD with an evaluation of birth outcomes (low birth weight, small for gestational age, preterm birth), in the global context without design restriction were included. The Newcastle Ottawa Scale and the Cochrane Risk of Bias tool were used to assess the risk of bias. The results are summarized in a table, and odds ratios were pooled where possible. Between-study heterogeneity was evaluated using I2 statistics. Potential publication bias was assessed using a funnel plot and Egger's regression test. To explore the robustness, a leave-one-out sensitivity analysis was conducted.

RESULTS

Thirty-three studies were used to synthesize narrative evidence (low birth weight: 31, preterm birth: 9, and small for gestational age: 4). In contrast, 24 records for low birth weight, eight for preterm birth, and four for small for gestational age were used to pool the results quantitatively. Of the 31 studies, 17 reported a positive association between maternal DD and infant birth weight, 13 studies reported a neutral association (not statistically significant), and one study reported a negative association. Overall, inadequate DD increased the risk of low birth weight OR = 1.71, 95% CI; (1.24-2.18), with I2 of 68.7%. No significant association was observed between maternal DD and preterm birth. Inadequate DD was significantly associated with small for gestational age (OR = 1.32, 95% CI; 1.15-1.49, and I2 = 0.0%).

CONCLUSION

Inadequate maternal DD is associated with an increased risk of low birth weight and small for gestational age but not preterm birth, underscoring the importance of promoting adequate DD during pregnancy. To address these issues, it is essential to implement and expand nutritional programs targeted at pregnant women, especially in low-resource settings, to ensure they receive diverse and adequate diets. Further research is needed to address the current limitations and to explore the long-term implications of maternal nutrition on child health. The study was prospectively registered on PROSPERO (registration number CRD42024513197). No funding was received for this study.

Association between Sexual Activity during Pregnancy, Pre- and Early-Term Birth, and Vaginal Cytokine Inflammation: A Prospective Study of Black Women

This study aimed to investigate the association between sexual activity during pregnancy and adverse birth outcomes among Black women, and to explore whether vaginal cytokine inflammation mediates this association. Data from 397 Black pregnant women through questionnaires on sexual activity and vaginal biosamples during early (8-14 weeks) and late (24-30 weeks) pregnancy, and birth outcomes were analyzed. Using a data-driven approach, the study found that vaginal sex during late pregnancy was associated with spontaneous early-term birth (sETB, 38-39 completed weeks' gestation) (OR = 0.39, 95% CI: [0.21, 0.72], p-value = 0.003) but not with spontaneous preterm birth (sPTB) (OR = 1.08, p-value = 0.86) compared to full-term birth. Overall, despite vaginal sex in late pregnancy showing an overall positive effect on sETB (total effect = -0.1580, p-value = 0.015), we observed a negative effect of vaginal sex on sETB (indirect effect = 0.0313, p-value = 0.026) due to the fact that having vaginal sex could lead to elevated IL6 levels, which in turn increased the odds of sETB. In conclusion, the study found an overall positive association between sexual activity on ETB and a negative partial mediation effect via increased vaginal cytokine inflammation induced by vaginal sexual activity. This inconsistent mediation model suggested that vaginal sexual activity is a complex behavior that could have both positive and negative effects on the birth outcome.

The Effects of Pregnancy: A Systematic Review of Adolescent Pregnancy in Ghana, Liberia, and Nigeria

There is a high incidence of adolescent pregnancy in West Africa. The objective of this study is to highlight the health impacts of adolescent pregnancy through a systematic review. A search was conducted in the electronic databases of Google, Google Scholar, SCOPUS, EBSCO, CINAHL, Web of Science, African Journals Online (AJOL), and the Demographic Health Surveys (DHS) Program. The study found anemia, complications of pregnancy, obstetric and gynecological risks, unsafe abortions, and psychological effects to adversely impact the health of adolescent girls in Ghana, Liberia, and Nigeria. Pregnancy could be deleterious to the health and well-being of adolescent girls in various forms. In addition, adolescent pregnancy could expose adolescent girls to gender-based violence, exclusions, and inequities, be detrimental to upholding women's sexual and reproductive health rights, and could also have implications for Sustainable Development Goal 3. Targeted interventions to prevent pregnancy in young women and mitigate these effects by stakeholders are encouraged.

Dietary and Nutrient Intake, Eating Habits, and ItsAssociation with Maternal Gestational Weight Gain and Offspring’s Birth Weight in Pregnant Adolescents

Pregnant adolescents’ diet and eating habits are inadequate; however, their association with gestational weight gain (GWG) is uncertain. We aimed to analyze whether there is an association between dietary and nutrient intake and eating habits with GWG among pregnant adolescents and their offspring’s birth weight. A longitudinal study was performed with 530 participants. We assessed GWG and applied several tools, such as a food frequency questionnaire and 24-h recall, to obtain dietary and nutrient intake and eating habits. The birth weight of adolescents’ offspring was registered. Later, we performed crude and adjusted Poisson models. The mean age was 15.8 ± 1.3 years. Of all food groups, the lowest frequency of adequate intake corresponded to vegetables (7%) and legumes (10.2%). Excessive (36.8%) and insufficient (40.9%) GWG were observed. Pregnant adolescents with inadequate legumes intake increased the probability of excessive GWG: (PR 1.86 95% CI 1.00–3.44). Cereals and grains were positively associated with GWG: (PR 1.65, 95% CI 1.18–2.29). Energy, macronutrient intake, and eating habits were not associated with GWG. Offspring’s small gestational age (SGA) increased when pregnant adolescents had inadequate sugar-sweetened beverages intake: PR (1.58, 95% CI 1.01–2.49) and when pregnant adolescent watched television (TV). In our sample of Mexican adolescents, dietary and nutrient intake and eating habits were inadequate. Excessive dietary intake from cereals, grains, and animal-sourced foods along with insufficient legumes were associated with excessive GWG. Watching TV while adolescents ate was associated with the birth weight of the offspring.

Educational attainment and offspring birth weight: A bidirectional Mendelian randomization study

Background: The association between educational attainment (EA) and offspring birth weight (BW) has been reported by several traditional epidemiological studies. However, evidence for this association tends to be mixed and confounded. This study aimed to investigate the causal association between EA of parents and offspring BW. Methods: Here, we carried out a two-sample bidirectional Mendelian randomization (MR) analysis to examine the causal association between EA of males (n = 131,695) and females (n = 162,028) and offspring BW using genetic instruments. Summary statistics of EA associated single nucleotide polymorphisms (SNPs) were extracted from a GWAS incorporating 293,723 individuals of European descent performed by the Social Science Genetic Association Consortium (SSGAC), and the effects of these SNPs on offspring BW were estimated using a GWAS meta-analysis of 86,577 participants of European descent from 25 studies. Univariable MR analyses were conducted using the inverse-variance weighted (IVW) method and four other methods. Further sensitivity analyses were carried out to test the viability of the results. Multivariable MR was used to examine the confounders between the exposure and outcome. Results: The result shows evidence that the offspring BW is positively causally affected by female EA. Each one standard deviation (SD) increase in female EA was associated with 0.24 SD higher of offspring BW (95% confidence interval [CI], 0.10 to 0.37, p < 0.001 for the IVW method). Similarly, change in offspring BW was 0.21 SD (95% CI: 0.07 to 0.34, p = 2.82 × 10-3) per one SD higher in male EA. No causal effect of BW on EA was found by any of the five methods. The causal association between female EA and offspring BW maintained after adjusting for alcoholic drinks per week and BMI. The effect of male EA on offspring BW was attenuated when we adjusted for BMI and alcoholic drinks per week using multivariable MR analysis. Conclusion: Our study indicated that female EA is positively causally associated with offspring BW. The association between male EA and offspring BW may be confounded by alcoholic drinks per week and BMI.