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Kumar N, Yadav A. Influence of fetal gender on overall perinatal outcome: a prospective observational study. Minerva Pediatr (Torino) 2023; 75:795-802. [PMID: 32241105 DOI: 10.23736/s2724-5276.20.05650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND Fetal gender is considered as one of significant predictors of pregnancy and perinatal outcome. The aim of this study is to assess impact of fetal gender on perinatal outcome. METHODS Present observational study was conducted in Obstetrics and Gynecology department of rural tertiary center of Northern India over one year (January-December 2018) on all randomly selected antenatal women at gestation ≥28 weeks, delivering by any route (cesarean/vaginal) and fulfilling inclusion criteria were enrolled. Immediately after delivery, neonatal birth weight was measured using table top beam weighing scale. Apgar scores at 1- and 5-minutes, Neonatal Intensive Care Unit admission, neonatal complications were assessed by pediatrician. Adverse perinatal outcome including neonatal morbidities (prematurity, neonatal intensive care unit admission, neonatal complications) and perinatal mortality were compared between two genders. Statistical analysis was done using SPSS 22 version software. RESULTS Of 3085 delivered neonates, 1450 (47%) were females, 1,633(52.9%) males and two (0.06%) had ambiguous genitalia, hence excluded. Mean values for neonatal birth weight for males was 2.77±0.540 kg and females 2.65±0.506 kg (P=0.0000). One- and 5-minute Apgar scores for male neonate were 6.81±1.565, 8.51±1.841 and for females 6.98±1.184, 8.70±1.383, respectively (P=0.001). NICU admission rate, need for oxygen and intubation, complications were significantly higher for male neonates (P<0.05) whereas females had higher incidence of intra-uterine growth restriction (P=0.000). Intra-uterine deaths were also more common with male gender (P=0.007). No significant difference was observed between two genders in relation to gestation at birth (P>0.05). CONCLUSIONS Male neonates had higher birth weight, but adverse perinatal outcome as compared to females.
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Affiliation(s)
- Naina Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Mangalagiri, India -
| | - Ashu Yadav
- Department of Obstetrics and Gynecology, Institute of Medical Sciences and Research, Maharishi Markandeshwar, Ambala, India
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Sitarik AR, Johnson CC, Levin AM, Lynch SV, Ownby DR, Rundle AG, Straughen JK, Wegienka G, Woodcroft KJ, Cassidy-Bushrow AE. Progression of C-reactive protein from birth through preadolescence varies by mode of delivery. Front Pediatr 2023; 11:1155852. [PMID: 37388285 PMCID: PMC10304017 DOI: 10.3389/fped.2023.1155852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Delivery via caesarean section (C-section) has been associated with an increased risk of childhood chronic diseases such as obesity and asthma, which may be due to underlying systemic inflammation. However, the impact of specific C-section types may be differential, as emergency C-sections typically involve partial labor and/or membrane rupture. Our objectives were to determine if mode of delivery associates with longitudinal profiles of high sensitivity CRP (hs-CRP) -a marker of systemic inflammation-from birth through preadolescence, and to examine if CRP mediates the association between mode of delivery and preadolescent body mass index (BMI). Methods Data from the WHEALS birth cohort (N = 1,258) were analyzed; 564 of the 1,258 children in the cohort had data available for analysis. Longitudinal plasma samples (birth through 10-years of age) from 564 children from were assayed for hs-CRP levels. Maternal medical records were abstracted to obtain mode of delivery. Growth mixture models (GMMs) were used to determine classes of hs-CRP trajectories. Poisson regression with robust error variance was used to calculate risk ratios (RRs). Results Two hs-CRP trajectory classes were identified: class 1 (76% of children) was characterized by low hs-CRP, while class 2 (24% of children) was characterized by high and steadily increasing hs-CRP. In multivariable models, children delivered via planned C-section had 1.15 times higher risk of being in hs-CRP class 2, compared to vaginal deliveries (p = 0.028), while no association was found for unplanned C-section deliveries [RR (95% CI) = 0.96 (0.84, 1.09); p = 0.49]. Further, the effect of planned C-section on BMI z-score at age 10 was significantly mediated by hs-CRP class (percent mediated = 43.4%). Conclusions These findings suggest potentially beneficial effects of experiencing partial or full labor, leading to a lower trajectory of systemic inflammation throughout childhood and decreased BMI during preadolescence. These findings may have implications for chronic disease development later in life.
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Affiliation(s)
- Alexandra R. Sitarik
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Christine C. Johnson
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Albert M. Levin
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Susan V. Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, United States
| | - Dennis R. Ownby
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
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Kibe PM, Mbuthia GW, Shikuku DN, Akoth C, Oguta JO, Ng'ang'a L, Gatimu SM. Prevalence and factors associated with caesarean section in Rwanda: a trend analysis of Rwanda demographic and health survey 2000 to 2019-20. BMC Pregnancy Childbirth 2022; 22:410. [PMID: 35578320 PMCID: PMC9112592 DOI: 10.1186/s12884-022-04679-y] [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: 10/19/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caesarean section (CS) is an important medical intervention for reducing the risk of poor perinatal outcomes. However, CS trends in sub-Saharan Africa (SSA) continue to increase yet maternal and neonatal mortality and morbidity remain high. Rwanda, like many other countries in SSA, has shown an increasing trend in the use of CS. This study assessed the trends and factors associated with CS delivery in Rwanda over the past two decades. METHODS We used nationally representative child datasets from the Rwanda Demographic and Health Survey 2000 to 2019-20. All births in the preceding 3 years to the survey were assessed for the mode of delivery. The participants' characteristics, trends and the prevalence of CS were analysed using frequencies and percentages. Unadjusted and adjusted logistic regression analyses were used to assess the factors associated with population and hospital-based CS in Rwanda for each of the surveys. RESULTS The population-based rate of CS in Rwanda significantly increased from 2.2% (95% CI 1.8-2.6) in 2000 to 15.6% (95% CI 13.9-16.5) in 2019-20. Despite increasing in all health facilities over time, the rate of CS was about four times higher in private (60.6%) compared to public health facilities (15.4%) in 2019-20. The rates and odds of CS were disproportionately high among women of high socioeconomic groups, those who resided in Kigali city, had multiple pregnancies, and attended at least four antenatal care visits while the odds of CS were significantly lower among multiparous women and those who had female babies. CONCLUSION Over the past two decades, the rate of CS use in Rwanda increased significantly at health facility and population level with high regional and socio-economic disparities. There is a need to examine the disparities in CS trends and developing tailored policy guidelines to ensure proper use of CS in Rwanda.
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Affiliation(s)
- Peter M Kibe
- African Population and Health Research Centre, Nairobi, Kenya.
| | - Grace Wambura Mbuthia
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Catherine Akoth
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - James Odhiambo Oguta
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,Health Section, UNICEF, Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | | | - Samwel Maina Gatimu
- Department of Economics, Population and Development Studies, University of Nairobi, Nairobi, Kenya.,Diabetic Foot Foundation Kenya, Nairobi, Kenya
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Arthurs AL, Smith MD, Hintural MD, Breen J, McCullough D, Thornton FI, Leemaqz SY, Dekker GA, Jankovic-Karasoulos T, Roberts CT. Placental Inflammasome mRNA Levels Differ by Mode of Delivery and Fetal Sex. Front Immunol 2022; 13:807750. [PMID: 35401528 PMCID: PMC8992795 DOI: 10.3389/fimmu.2022.807750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Parturition signals the end of immune tolerance in pregnancy. Term labour is usually a sterile inflammatory process triggered by damage associated molecular patterns (DAMPs) as a consequence of functional progesterone withdrawal. Activation of DAMPs recruits leukocytes and inflammatory cytokine responses in the myometrium, decidua, cervix and fetal membranes. Emerging evidence shows components of the inflammasome are detectable in both maternal decidua and placenta. However, the activation of the placental inflammasome with respect to mode of delivery has not been profiled. Placental chorionic villus samples from women delivering at term via unassisted vaginal (UV) birth, labouring lower segment caesarean section (LLSCS, emergency caesarean section) and prelabour lower segment caesarean section (PLSCS, elective caesarean section) underwent high throughput RNA sequencing (NextSeq Illumina) and bioinformatic analyses to identify differentially expressed inflammatory (DE) genes. DE genes (IL1RL1, STAT1, STAT2, IL2RB, IL17RE, IL18BP, TNFAIP2, TNFSF10 and TNFRSF8), as well as common inflammasome genes (IL1B, IL1R1, IL1R2, IL6, IL18, IL18R1, IL18R1, IL10, and IL33), were targets for further qPCR analyses and Western blotting to quantify protein expression. There was no specific sensor molecule-activated inflammasome which dominated expression when stratified by mode of delivery, implying that multiple inflammasomes may function synergistically during parturition. Whilst placentae from women who had UV births overall expressed pro-inflammatory mediators, placentae from LLSCS births demonstrated a much greater pro-inflammatory response, with additional interplay of pro- and anti-inflammatory mediators. As expected, inflammasome activation was very low in placentae from women who had PLSCS births. Sex-specific differences were also detected. Placentae from male-bearing pregnancies displayed higher inflammasome activation in LLSCS compared with PLSCS, and placentae from female-bearing pregnancies displayed higher inflammasome activation in LLSCS compared with UV. In conclusion, placental inflammasome activation differs with respect to mode of delivery and neonatal sex. Its assessment may identify babies who have been exposed to aberrant inflammation at birth that may compromise their development and long-term health and wellbeing.
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Affiliation(s)
- Anya L Arthurs
- Pregnancy Health and Beyond Laboratory, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Melanie D Smith
- Pregnancy Health and Beyond Laboratory, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Mhyles D Hintural
- Pregnancy Health and Beyond Laboratory, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - James Breen
- South Australian Genomics Centre, South Australian Health & Medical Research Institute, Adelaide, SA, Australia
| | - Dylan McCullough
- Pregnancy Health and Beyond Laboratory, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Francesca I Thornton
- Pregnancy Health and Beyond Laboratory, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Shalem Y Leemaqz
- Pregnancy Health and Beyond Laboratory, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Gustaaf A Dekker
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Tanja Jankovic-Karasoulos
- Pregnancy Health and Beyond Laboratory, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Claire T Roberts
- Pregnancy Health and Beyond Laboratory, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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Morales-Roselló J, Loscalzo G, Jakaitė V, Perales Marín A. The Diagnostic Ability of the Cerebroplacental Ratio for the Prediction of Adverse Perinatal Outcome and Intrapartum Fetal Compromise within One Day of Delivery. Gynecol Obstet Invest 2021; 86:343-352. [PMID: 34280926 DOI: 10.1159/000517260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate the diagnostic abilities of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome (APO) and cesarean section for intrapartum fetal compromise (CS-IFC) within 1 day of delivery. DESIGN Retrospective observational case-control study. METHODS This was a study of 254 high-risk fetuses attending the day hospital unit of a tertiary referral hospital that underwent an ultrasound examination at 32-41 weeks and gave birth within 1 day of examination. APO was defined as a composite of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH <7.20 requiring urgent cesarean section, neonatal umbilical cord pH <7.10, 5-min Apgar score <7, and postpartum admission to neonatal or pediatric intensive care units. CS-IFC was defined in case of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH <7.20 requiring urgent cesarean section. The diagnostic ability of CPR for the prediction of APO and CS-IFC was calculated alone and in combination with estimated fetal weight and gestational clinical parameters, including the type of labor onset, using ROC curves and logistic regression analysis. RESULTS CPR in multiples of the median (MoM) was a moderate predictor of APO (area under the curve [AUC] = 0.77, p < 0.0001) and CS-IFC (AUC = 0.82, p < 0.0001). The predictive abilities of the multivariable model for APO (AUC = 0.81, p < 0.0001) and CS-IFC (AUC = 0.82, p < 0.0001) did not differ from those of CPR alone . LIMITATIONS The small number of cases and the scarcity of information concerning labor induction. CONCLUSION In high-risk pregnancies, CPR MoM is a moderate predictor of APO and CS-IFC when performed within 24 h of delivery.
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Affiliation(s)
- José Morales-Roselló
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vaidilė Jakaitė
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alfredo Perales Marín
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
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Angeliki A, Dimitrios P, Chara T. Maternal obesity and its association with the mode of delivery and the neonatal outcome in induced labour: Implications for midwifery practice. Eur J Midwifery 2018; 2:4. [PMID: 33537565 PMCID: PMC7839088 DOI: 10.18332/ejm/85792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/27/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Maternal obesity carries an increased risk of complications during pregnancy and childbirth. This study investigated whether the body mass index (BMI) of women with induced labour was associated with the mode of delivery and neonatal outcome. METHODS This was a retrospective study of primigravidae women under the age of 40 years who were induced at term for various indications. Data were collected from the electronic database of the Maternity Unit where these women gave birth. RESULTS We sampled 1274 women with a mean age of 26.3±5.9 years. The mean BMI at booking was 26.5 kg/m2, with 28.8% being overweight and 24.3% obese. In the sample, 70.4% had a normal vaginal delivery, 15.4% a caesarean section (CS) and 14.2% an instrumental delivery. An increasing BMI was independently associated with the odds for a CS, with women who were overweight and obese having a 1.58 and 2.75 times greater likelihood for a CS. The CS rate was 10.2% in women with a normal BMI, and increased to 15.8% for overweight and 24.9% for obese women (p<0.001). The increasing BMI did not affect the instrumental delivery rates in our cohort. The Apgar scores at one and five minutes were significantly lower in overweight and obese women compared to women with a normal BMI. CONCLUSIONS We show that an increasing BMI in women with induced labour was associated with increased CS rates and lower Apgar scores. These findings highlight the important role of midwives in engaging women in weight management before they get pregnant.
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Affiliation(s)
- Antonakou Angeliki
- Department of Midwifery, Midwifery School, 'Alexander' Technological Educational Institute of Thessaloniki, Greece
| | - Papoutsis Dimitrios
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
| | - Tzavara Chara
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Greece
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