Maternal age as risk factor of prematurity in Spain; Mediterranean area

Developmental status of human immunodeficiency virus-exposed uninfected premature infants compared with premature infants who are human immunodeficiency virus unexposed and uninfected

Background

There is growing concern about the developmental outcome of infants exposed to HIV in utero. HIV-infected women are at greater risk of premature delivery which poses a further developmental risk factor.

Objectives

To determine whether there is a difference between the development of premature infants born at 28–37 weeks gestational age that are HIV exposed but uninfected (HEU) compared with HIV-unexposed uninfected infants (HUU).

Method

A cross-sectional study was conducted in a Johannesburg state hospital. Thirty HEU and 30 HUU infants, aged between 16 days and six months, were assessed using the Bayley Scales of Infant and Toddler Development III.

Results

The two groups were well matched for gestational age and birth weight; however, more HUU infants presented with neonatal complications. HUU infants had lower developmental scores than HEU infants in the language (p = 0.003) and motor (p = 0.037) subscales. Expressive language was more affected in the HUU infants (p = 0.001), and fine (p = 0.001) and gross motor (p = 0.03) were affected as well. HUU infants with neonatal complications such as meningitis (p = 0.02) and neonatal jaundice (NNJ) (p = 0.01) are more likely to present with language and motor delay.

Conclusion

Meningitis and NNJ have more impact on infant development than in-utero HIV and ARV exposure.

Clinical implications

It is important for all premature infants to be screened regularly in order to diagnose developmental delays early so as to ensure early intervention and improved quality of life.

Correlation of maternal-fetal attachment and health practices during pregnancy with neonatal outcomes

Introduction

Low birth weight due to preterm delivery or intrauterine growth restriction (IUGR) is the strongest factor contributing to prenatal, neonatal, and postnatal mortality. Maternal–fetal attachment plays a significant role in maternal and fetal health. Health practices performed by the mother during pregnancy constitute one of the factors that may affect neonatal outcomes. The present study was conducted to identify the relationship between maternal–fetal attachment and health practices during pregnancy with neonatal outcomes.

Methods

This cross-sectional study was conducted on 315 pregnant women with a gestational age of 33–41 weeks who presented to hospitals in Sirjan (Iran) between December 2014 and February 2015. The data collection tools used included the Health Practices in Pregnancy Questionnaire and the Maternal Fetal Attachment Scale. Data were analyzed using IBM-SPSS version 20, focusing on the Pearson product–moment correlation and the logistic regression model. Statistical significance was set to p<0.05.

Results

The mean score of maternal–fetal attachment was 60.34, and the mean score of health practices was 123.57. The mean birth weight of the neonates was 3052.38 g. Health practices (p<0.05, r=0.11) and maternal-fetal attachment (p<0.01, r=0.23) were positively and significantly correlated with neonatal outcomes. A significant positive relationship was also observed between maternal–fetal attachment and neonatal outcomes. No significant relationships were observed between health practices during pregnancy and neonatal outcomes.

Conclusion

Maternal-fetal attachment and health practices during pregnancy are positively and significantly correlated with neonatal outcomes.

Highest Plasma Phenylalanine Levels in (Very) Premature Infants on Intravenous Feeding; A Need for Concern

OBJECTIVE

To analyse the association in newborns between blood levels of phenylalanine and feeding method and gestational age.

STUDY DESIGN

This observational, cross-sectional study included a sample of 11,829 infants between 2008 and 2013 in a Spanish region. Data were recorded on phenylalanine values, feeding method [breast, formula, mixed (breast plus formula), or partial or fully intravenous feeding], gestational age in weeks (<32, 32-37, ≥37), gender and days since birth at the moment of blood collection. Outcomes were [phenylalanine] and [phenylalanine] ≥95th percentile. Associations were analysed using multivariate models [linear (means difference) and logistic regression (adjusted odds ratios)].

RESULTS

Higher phenylalanine values were associated with lower gestational age (p<0.001) and with intravenous feeding (p<0.001).

CONCLUSION

The degree of prematurity and intravenous feeding influenced the plasma concentration of phenylalanine in the newborn. Caution should be taken in [phenylalanine] for newborns with intravenous feeding, monitoring them carefully. Very preterm infants given the recommended amount of amino acids should also be strictly monitored. These findings should be taken into consideration and call for adapting the amounts to the needs of the infant.

Influence of immigration on prematurity in the context of a free healthcare system with universal coverage

We assessed the risk of preterm birth according to the mother’s place of origin in the context of a free and universal healthcare system. We analysed 75,292 newborn infants born between 2008-2011 in Alicante (Spain). The outcomes were: 1) very preterm (gestational age ≤32 weeks) and 2) moderate-to-late preterm (gestational age 33-37 weeks). Other variables: infant’s gender, maternal age and origin. We estimated adjusted odds ratios to analyse the relationship between the outcomes and the other variables. The distribution of the gestational age groups in our sample was: very preterm, 812; moderate-to-late preterm, 5,295; full-term, 69,997. There were no statistically significant differences between the mother’s place of origin and the outcomes in this free universal healthcare system, which is experiencing the recent phenomenon of immigration. This equality should be maintained throughout the time the immigrants remain in the country.

Smoking cessation advice recorded during pregnancy in United Kingdom primary care

BACKGROUND

United Kingdom (UK) national guidelines recommend that all pregnant women who smoke should be advised to quit at every available opportunity, and brief cessation advice is an efficient and cost-effective means to increase quit rates. The Quality and Outcomes Framework (QOF) implemented in 2004 requires general practitioners to document their delivery of smoking cessation advice in patient records. However, no specific targets have been set in QOF for the recording of this advice in pregnant women. We used a large electronic primary care database from the UK to quantify the pregnancies in which women who smoked were recorded to have been given smoking cessation advice, and the associated maternal characteristics.

METHODS

Using The Health Improvement Network database we calculated annual proportions of pregnant smokers between 2000 and 2009 with cessation advice documented in their medical records during pregnancy. Logistic regression was used to assess variation in the recording of cessation advice with maternal characteristics.

RESULTS

Among 45,296 pregnancies in women who smoked, recorded cessation advice increased from 7% in 2000 to 37% in 2004 when the QOF was introduced and reduced slightly to 30% in 2009. Pregnant smokers from the youngest age group (15-19) were 21% more likely to have a record of cessation advice compared to pregnant smokers aged 25-29 (OR 1.21, 95% CI 1.10-1.35) and pregnant smokers from the most deprived group were 38% more likely to have a record for cessation advice compared to pregnant smokers from the least deprived group (OR 1.38, 95% CI 1.14-1.68). Pregnant smokers with asthma were twice as likely to have documentation of cessation advice in their primary care records compared to pregnant smokers without asthma (OR 1.97, 95% CI 1.80-2.16). Presence of comorbidities such as diabetes, hypertension and mental illness also increased the likelihood of having smoking cessation advice recorded. No marked variations were observed in the recording of cessation advice with body mass index.

CONCLUSION

Recorded delivery of smoking cessation advice for pregnant smokers in primary care has increased with some fluctuation over the years, especially after the implementation of the QOF, and varies with maternal characteristics.