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Okunade KS, Adejimi AA, Olumodeji AM, Olowe A, Oyedeji OA, Ademuyiwa IY, Adelabu H, Toks-Omage E, Okoro AC, Davies N, Adenekan MA, Ojo T, Rabiu KA, Oshodi YA, Ugwu AO, Olowoselu FO, Akinmola OO, Olamijulo JA, Oluwole AA. Prenatal anaemia and risk of postpartum haemorrhage: a cohort analysis of data from the Predict-PPH study. BMC Public Health 2024; 24:1028. [PMID: 38609913 PMCID: PMC11015669 DOI: 10.1186/s12889-024-18446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Most previous clinical studies investigating the connection between prenatal anaemia and postpartum haemorrhage (PPH) have reported conflicting results. OBJECTIVES We examined the association between maternal prenatal anaemia and the risk of PPH in a large cohort of healthy pregnant women in five health institutions in Lagos, Southwest Nigeria. METHODS This was a prospective cohort analysis of data from the Predict-PPH study that was conducted between January and June 2023. The study enrolled n = 1222 healthy pregnant women giving birth in five hospitals in Lagos, Nigeria. The study outcome, WHO-defined PPH, is postpartum blood loss of at least 500 milliliters. We used a multivariable logistic regression model with a backward stepwise conditional approach to examine the association between prenatal anaemia of increasing severity and PPH while adjusting for confounding factors. RESULTS Of the 1222 women recruited to the Predict-PPH study between January and June 2023, 1189 (97·3%) had complete outcome data. Up to 570 (46.6%) of the enrolled women had prenatal anaemia while 442 (37.2%) of those with complete follow-up data had WHO-defined PPH. After controlling for potential confounding factors, maternal prenatal anaemia was independently associated with PPH (adjusted odds ratio = 1.37, 95% confidence interval: 1.05-1.79). However, on the elimination of interaction effects of coexisting uterine fibroids and mode of delivery on this association, a sensitivity analysis yielded a lack of significant association between prenatal anaemia and PPH (adjusted odds ratio = 1.27, 95% confidence interval: 0.99-1.64). We also recorded no statistically significant difference in the median postpartum blood loss in women across the different categories of anaemia (P = 0.131). CONCLUSION Our study revealed that prenatal anaemia was not significantly associated with PPH. These findings challenge the previously held belief of a suspected link between maternal anaemia and PPH. This unique evidence contrary to most previous studies suggests that other factors beyond prenatal anaemia may contribute more significantly to the occurrence of PPH. This highlights the importance of comprehensive assessment and consideration of various maternal health factors in predicting and preventing this life-threatening obstetric complication.
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria.
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria.
- Centre for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria.
| | - Adebola A Adejimi
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Ayokunle M Olumodeji
- Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Atinuke Olowe
- Department of Nursing Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Olufemi A Oyedeji
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Iyabo Y Ademuyiwa
- Department of Nursing Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Hameed Adelabu
- Centre for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Eselobu Toks-Omage
- Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Austin C Okoro
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nosimot Davies
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Muisi A Adenekan
- Department of Obstetrics & Gynaecology, Lagos Island Maternity Hospital, Lagos Island, Nigeria
| | - Temitope Ojo
- Department of Obstetrics & Gynaecology, Federal Medical Center, Ebute-Meta, Lagos, Nigeria
| | - Kabiru A Rabiu
- Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Yusuf A Oshodi
- Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Aloy O Ugwu
- Department of Obstetrics & Gynaecology, 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria
| | - Festus O Olowoselu
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olukayode O Akinmola
- Department of Chemical Pathology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Joseph A Olamijulo
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ayodeji A Oluwole
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
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Grzeszczak K, Łanocha-Arendarczyk N, Malinowski W, Ziętek P, Kosik-Bogacka D. Oxidative Stress in Pregnancy. Biomolecules 2023; 13:1768. [PMID: 38136639 PMCID: PMC10741771 DOI: 10.3390/biom13121768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Recent years have seen an increased interest in the role of oxidative stress (OS) in pregnancy. Pregnancy inherently heightens susceptibility to OS, a condition fueled by a systemic inflammatory response that culminates in an elevated presence of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in the circulatory system. The amplified OS in pregnancy can trigger a series of detrimental outcomes such as underdevelopment, abnormal placental function, and a host of pregnancy complications, including pre-eclampsia, embryonic resorption, recurrent pregnancy loss, fetal developmental anomalies, intrauterine growth restriction, and, in extreme instances, fetal death. The body's response to mitigate the uncontrolled increase in RNS/ROS levels requires trace elements that take part in non-enzymatic and enzymatic defense processes, namely, copper (Cu), zinc (Zn), manganese (Mn), and selenium (Se). Determination of ROS concentrations poses a challenge due to their short half-lives, prompting the use of marker proteins, including malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR), catalase (CAT), and glutathione (GSH). These markers, indicative of oxidative stress intensity, can offer indirect assessments of pregnancy complications. Given the limitations of conducting experimental studies on pregnant women, animal models serve as valuable substitutes for in-depth research. This review of such models delves into the mechanism of OS in pregnancy and underscores the pivotal role of OS markers in their evaluation.
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Affiliation(s)
- Konrad Grzeszczak
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.G.); (N.Ł.-A.)
- Department of Laboratory Diagnostics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Natalia Łanocha-Arendarczyk
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.G.); (N.Ł.-A.)
| | - Witold Malinowski
- Faculty of Health Sciences, The Masovian. Public University in Płock, Plac Dąbrowskiego 2, 09-402 Płock, Poland;
| | - Paweł Ziętek
- Department of Orthopaedics, Traumatology and Orthopaedic Oncology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Danuta Kosik-Bogacka
- Independent Laboratory of Pharmaceutical Botany, Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111 Szczecin, Poland
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Paquette AG, MacDonald J, Bammler T, Day DB, Loftus CT, Buth E, Mason WA, Bush NR, Lewinn KZ, Marsit C, Litch JA, Gravett M, Enquobahrie DA, Sathyanarayana S. Placental transcriptomic signatures of spontaneous preterm birth. Am J Obstet Gynecol 2023; 228:73.e1-73.e18. [PMID: 35868418 PMCID: PMC9790028 DOI: 10.1016/j.ajog.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/01/2022] [Accepted: 07/09/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Spontaneous preterm birth accounts for most preterm births and leads to significant morbidity in the newborn and childhood period. This subtype of preterm birth represents an increasing proportion of all preterm births when compared with medically indicated preterm birth, yet it is understudied in omics analyses. The placenta is a key regulator of fetal and newborn health, and the placental transcriptome can provide insight into pathologic changes that lead to spontaneous preterm birth. OBJECTIVE This analysis aimed to identify genes for which placental expression was associated with spontaneous preterm birth (including early preterm and late preterm birth). STUDY DESIGN The ECHO PATHWAYS consortium extracted RNA from placental samples collected from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood and the Global Alliance to Prevent Prematurity and Stillbirth studies. Placental transcriptomic data were obtained by RNA sequencing. Linear models were fit to estimate differences in placental gene expression between term birth and spontaneous preterm birth (including gestational age subgroups defined by the American College of Obstetricians and Gynecologists). Models were adjusted for numerous confounding variables, including labor status, cohort, and RNA sequencing batch. This analysis excluded patients with induced labor, chorioamnionitis, multifetal gestations, or medical indications for preterm birth. Our combined cohort contained gene expression data for 14,023 genes in 48 preterm and 540 term samples. Genes and pathways were considered statistically significantly different at false discovery rate-adjusted P value of <.05. RESULTS In total, we identified 1728 genes for which placental expression was associated with spontaneous preterm birth with more differences in expression in early preterm samples than late preterm samples when compared with full-term samples. Of those, 9 genes were significantly decreased in both early and late spontaneous preterm birth, and the strongest associations involved placental expression of IL1B, ALPL, and CRLF1. In early and late preterm samples, we observed decreased expression of genes involved in immune signaling, signal transduction, and endocrine function. CONCLUSION This study provides a comprehensive assessment of the differences in the placental transcriptome associated with spontaneous preterm birth with robust adjustment for confounding. Results of this study are in alignment with the known etiology of spontaneous preterm birth, because we identified multiple genes and pathways for which the placental and chorioamniotic membrane expression was previously associated with prematurity, including IL1B. We identified decreased expression in key signaling pathways that are essential for placental growth and function, which may be related to the etiology of spontaneous preterm birth. We identified increased expression of genes within metabolic pathways associated exclusively with early preterm birth. These signaling and metabolic pathways may provide clinically targetable pathways and biomarkers. The findings presented here can be used to understand underlying pathologic changes in premature placentas, which can inform and improve clinical obstetrics practice.
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Affiliation(s)
- Alison G Paquette
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA.
| | - James MacDonald
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Theo Bammler
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Drew B Day
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Erin Buth
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - W Alex Mason
- Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, University of San Francisco, San Francisco, CA; Department of Pediatrics, University of San Francisco, San Francisco, CA
| | - Kaja Z Lewinn
- Department of Psychiatry and Behavioral Sciences, University of San Francisco, San Francisco, CA
| | - Carmen Marsit
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | - James A Litch
- Global Alliance to Prevent Preterm Birth and Stillbirth (GAPPS), Lynnwood, WA
| | - Michael Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA
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Hogan C, Perkins AV. Selenoproteins in the Human Placenta: How Essential Is Selenium to a Healthy Start to Life? Nutrients 2022; 14:nu14030628. [PMID: 35276987 PMCID: PMC8838303 DOI: 10.3390/nu14030628] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
Abstract
Selenium is an essential trace element required for human health, and selenium deficiency has been associated with many diseases. The daily recommended intake of selenium is 60 µg/day for adults, which increases to 65 µg/day for women when pregnant. Selenium is incorporated into the 21st amino acid, selenocysteine (sec), a critical component of selenoproteins that plays an important role in a variety of biological responses such as antioxidant defence, reactive oxygen species (ROS) signalling, formation of thyroid hormones, DNA synthesis and the unfolded protein response in the endoplasmic reticulum (ER). Although 25 selenoproteins have been identified, the role of many of these is yet to be fully characterised. This review summarises the current evidence demonstrating that selenium is essential for a healthy pregnancy and that poor selenium status leads to gestational disorders. In particular, we focus on the importance of the placental selenoproteome, and the role these proteins may play in a healthy start to life.
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Erol SA, Polat N, Akdas S, Aribal Ayral P, Anuk AT, Ozden Tokalioglu E, Goncu Ayhan Ş, Kesikli B, Ceylan MN, Tanacan A, Moraloglu Tekin Ö, Yazihan N, Sahin D. Maternal selenium status plays a crucial role on clinical outcomes of pregnant women with COVID-19 infection. J Med Virol 2021; 93:5438-5445. [PMID: 33951210 PMCID: PMC8242645 DOI: 10.1002/jmv.27064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/29/2021] [Accepted: 04/30/2021] [Indexed: 12/21/2022]
Abstract
Adequate maternal selenium level is essential for immune response and healthy pregnancy. This study aimed to shed light on the selenium status of pregnant women with COVID-19 and the effects of potential deficiency in serum selenium levels. Totally 141 pregnant women, 71 of them were COVID-19 patients, in different trimesters were included in the study. Maternal serum selenium levels, demographic and clinical parameters were determined. Serum selenium levels of pregnant women in the second (p: .0003) and third (p: .001) trimesters with COVID-19 were significantly lower than in the healthy group. Maternal selenium level was found to be negatively correlated with gestational week (p < .0001, r: -.541), D-dimer (p: .0002, r: -.363) and interleukin-6 (IL-6) level (p: .02, r: -.243). In the second trimester, serum selenium level positively correlated with white blood cell (p: .002, r: .424), neutrophil (p: .006, r: .39), lymphocyte (p: .004, r: .410) count and hemoglobin (p: .02, r: .323), hematocrit (p: .008, r: .38) status. In the third trimester, it was found that maternal selenium level positively correlated with monocyte (p: .04, r: .353) and negatively correlated with C-reactive protein level (p: .03, r: -.384). Serum selenium level was gradually decreased during the pregnancy period, however, this natural decrease was enhanced together with COVID-19 infection. The reason might be increased selenium needs depended on the immune response against infection. The decrease in maternal selenium level was found to be related to IL-6 and D-dimer levels, which indicate selenium's role in disease progression.
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Affiliation(s)
- Seyit Ahmet Erol
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Naci Polat
- Department of Pathophysiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sevginur Akdas
- Interdisciplinary Food, Metabolism and Clinical Nutrition Department, Institute of Health, Ankara University, Ankara, Turkey
| | - Pelin Aribal Ayral
- Department of Pathophysiology, Ankara University Faculty of Medicine, Ankara, Turkey.,Interdisciplinary Food, Metabolism and Clinical Nutrition Department, Institute of Health, Ankara University, Ankara, Turkey
| | - Ali Taner Anuk
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Eda Ozden Tokalioglu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Şule Goncu Ayhan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Burcu Kesikli
- Department of Pathophysiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Nur Ceylan
- Interdisciplinary Food, Metabolism and Clinical Nutrition Department, Institute of Health, Ankara University, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Özlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, University of Health Sciences, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Nuray Yazihan
- Department of Pathophysiology, Ankara University Faculty of Medicine, Ankara, Turkey.,Interdisciplinary Food, Metabolism and Clinical Nutrition Department, Institute of Health, Ankara University, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, University of Health Sciences, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Okunade KS, Olowoselu OF, John-Olabode S, Hassan BO, Akinsola OJ, Nwogu CM, Ugwu AO, Moses OE, Rabiu KA, Ajepe A, Adenekan MA, Adejimi AA, Akanmu SA, Kanki PJ. Effects of selenium supplementation on pregnancy outcomes and disease progression in HIV-infected pregnant women in Lagos: A randomized controlled trial. Int J Gynaecol Obstet 2021; 153:533-541. [PMID: 33275775 DOI: 10.1002/ijgo.13514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/25/2020] [Accepted: 12/01/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine the effects of selenium supplementation on pregnancy outcomes and disease progression among HIV-infected pregnant women in Lagos. METHODS A randomized, placebo-controlled trial conducted among HIV-positive pregnant women between September 2018 and August 2019. At enrollment, 90 women were randomly assigned into each treatment arm to receive either a daily tablet of 200 μg elemental selenium or a placebo. Relevant participants' sociodemographic and clinical data were collected at enrollment and delivery. RESULTS Women in the selenium arm had a significantly lower risk of preterm delivery (relative risk [RR] 0.32, 95% confidence interval [CI] 0.11-0.96) and a non-significant reduction in the risk of delivering term neonates with a low delivery weight (RR 0.24, 95% CI 0.05-1.19). Supplemental selenium does not increase the risk of perinatal death and adverse drug events. CONCLUSION The study reported a beneficial effect of prenatal selenium supplements on the risk of preterm delivery with no further reduction in risk among HIV-infected women who used the supplements for more than 14 weeks. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR201809756724274).
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olusola F Olowoselu
- Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sarah John-Olabode
- Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Basirat O Hassan
- AIDS Prevention Initiative in Nigeria (APIN) Clinic, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwatosin J Akinsola
- Department of Community Health and Primary Health Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Chidinma M Nwogu
- Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Aloy O Ugwu
- Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olusanjo E Moses
- Department of Obstetrics and Gynecology, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Kabiru A Rabiu
- Department of Obstetrics and Gynecology, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Adegbenga Ajepe
- Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Muisi A Adenekan
- Department of Obstetrics and Gynecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adebola A Adejimi
- Department of Community Health and Primary Health Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sulaimon A Akanmu
- Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
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