Top PDF Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China.

Several strengths and limitations should be noted when interpreting the results of our study. A clear strength of this study is the large population-based cohort of pregnant women. Also, the women’s anthropometric characteristics during early pregnancy were available, which allowed us to evaluate the role of both total GWG and early GWG in relation to risk of HDP. To our knowledge, we are only the second study to examine the association of early GWG with the risk of HDP, and the first among Asian women. Several limitations of this study should also be considered. First, though we assessed some potential confounding factors previously reported to influence HDP, there were several other potential confounders that we were not able to evaluate, such as smoking status and family history of HDP, because of the absence of this information in our database. However, we note that the smoking prevalence of women in China is very low [31] and we excluded women with a history of chronic hypertension or car- diovascular disease prior to pregnancy from the study. Additionally, our study relies on a self- reported pre-pregnancy weight, which may be under estimated. Although potential misclassifi- cation bias may exist, previous studies suggest that the resulting BMI category from self- reported data rarely alters, and the self-reported weight and height may be considered to be an acceptable substitute for actual measurements [28, 32].

One major limitation of our study is the lack of an objective method such as overnight poly- somnogram (PSG) to measure habitual snoring. However, the aim of this study was to validate the use of snoring directly predicting adverse pregnancy outcomes, and existing literature has confirmed that self-reported snoring was strongly associated with the PSG-derived sleep apnea hypopnea index [48–50]. We also used self-reported weight and height data to calculate pre- pregnancy BMI, which may increase measurement bias, and pre-pregnancy overweight and obesity possesses a lower proportion than the West reported, this could be a large limitation to examine for adverse pregnancy outcomes, While in this study, though pre-pregnancy over- weight and obesity accounts for a low percentage, it acts as an important role in mediating both adverse maternal and neonatal outcomes, when snoring status was stratified by pre-preg- nancy BMI, further significant associations between snoring and adverse outcomes were found. Moreover, the low percentage of pre-pregnancy overweight/obesity may result in the lower prevalence of snoring in pregnancy in this study than previously published literature, as studies suggested that overweight and obese pregnant women were at higher risk of sleep-dis- ordered breathing than their lean weight counterparts [24,25]. Another weakness is that only pregnant women whose obstetrics visit was at the MCH Care Center were included, even though the center contains about 80% of pregnant women. This may likely to increase the selection bias, and the results are difficult to promote to the whole country.

aged between 18–24, 25–34, and 35–44 years old (24.4, 38%, and 50.9% respectively). 4 Such a scenario suggests that obste- tricians are dealing more frequently with pregnant women who are overweight and obese and, therefore, have increased risks of poor maternal and child health outcomes. Tennant et al 5 found an increased risk of fetal and infant death in a cohort of women who were obese at the beginning of pregnancy compared with women who had the recommended weight, and preeclampsia commonly caused fetal deaths among obese women. Additionally, Aune et al, 6 in a systematic review and meta-analysis, showed that high a BMI during pregnancy was associated with fetal death, stillbirth, and neonatal, perinatal, and infant death. Nohr et al 7 reported an association between high pre-pregnancy BMI and excessive maternal weight gain with an increased risk of cesarean delivery (CD), and infants large for their gestational age or with a low Apgar score. 7 Even Conclusion We observed that pre-pregnancy obesity was associated with maternal age, hyperglycemic disorders, hypertension syndrome, cesarean deliveries, fetal macrosomia, and fetal acidosis.

Our study also assessed the joint association of maternal pre-pregnancy BMI and GWG with the risks of offspring overweight at birth and 1–5 years old at baseline survey. We found that offspring born to GDM mothers with pre-pregnancy overweight/obesity and excessive GWG presented the highest risk of macrosomia and large for gestational age at birth and over- weight at 1–5 years old compared with those born to GDM mothers with pre-pregnancy nor- mal weight and adequate GWG. Another important observation was that the associations of maternal excessive GWG with macrosomia and large for gestational overweight of their off- spring at birth were similar to that of maternal pre-pregnancy overweight/obesity, but the effects of maternal excessive GWG on their offspring’s overweight status at 1–5 years old were smaller than that of maternal pre-pregnancy overweight/obesity. This finding was confirmed in the subgroup analyses that the association of childhood overweight with maternal pre-preg- nancy obesity tended to be larger among older children, while the association of childhood overweight with maternal excessive GWG tended to be smaller among older children. Previous studies suggested that among the general population, maternal pre-pregnancy overweight was a risk factor for both early onset overweight (persisted throughout childhood) and late onset overweight (after age 8) of their offspring, while maternal excessive GWG was only associated with the early onset overweight of their offspring [15]. Although offspring of mothers exposed to GDM are at increased risk of neonatal adiposity and childhood obesity after 5 years old, it is not clear whether the effect of GDM mothers with excessive GWG on offspring overweight will begin to attenuate with the growth of offspring. Thus, future studies are needed to answer this question.

A strength of this study is that the sample was random and population based, concerning the population of the city of São Luís, state of Maranhão, Brazil. Another relevant point is the statistical method used to test the association of pre-pregnancy BMI and gestational weight gain with birth weight, i.e., the modeling of stuctural equations. By being able to estimate a series of separate and interdependent multiple regression equations, this method tends to yield more reliable results. Moreover, it allows the estimate of the total, direct, and indirect effects between variables, presenting the ones that are mediating the total effect. In addition, this method yields results that are easy to interpret and allows us to work with initial losses of variables that can be imputed by the method of estimation 8 .

Background. Each year, ten million women develop pre- eclampsia or a related hypertensive (high blood pressure) disorder of pregnancy and 76,000 women die as a result. Globally, hypertensive disorders of pregnancy cause around 12% of maternal deaths—deaths of women during or shortly after pregnancy. The mildest of these disorders is gestational hypertension, high blood pressure that develops after 20 weeks of pregnancy. Gestational hypertension does not usually harm the mother or her unborn child and resolves after delivery but up to a quarter of women with this condition develop pre-eclampsia, a combination of hyper- tension and protein in the urine (proteinuria). Women with mild pre-eclampsia may not have any symptoms—the condition is detected during antenatal checks—but more severe pre-eclampsia can cause headaches, blurred vision, and other symptoms, and can lead to eclampsia (fits), multiple organ failure, and death of the mother and/or her baby. The only ‘‘cure’’ for pre-eclampsia is to deliver the baby as soon as possible but women are sometimes given antihypertensive drugs to lower their blood pressure or magnesium sulfate to prevent seizures.

Crude and adjusted odds ratios for various putative risk factors for gestational diabetes and pre-eclampsia are shown in Table 2. A common pattern of associations was seen for age, BMI, waist circumference and early preg- nancy weight gain. Additionally, each condition predicted the other. Due to a very small number of pre-eclampsia cases in Manaus, data was excluded from this centre in multiple logistic regression analysis. Table 2 shows that, in models simultaneously investigating age, pre-pregnancy BMI, early pregnancy weight gain, parity, study centre and smoking, the first three factors were associated with higher odds of developing both gestational diabetes and pre-eclampsia. Interestingly, smokers during pregnancy showed a tendency toward protection for both gestational diabetes (OR=0.69; 95% CI 0.50-0.96) and pre-eclamp- sia (OR=0.68; 95% CI 0.41-1.11).

Regarding offspring outcomes, we found that only 7% of birth weight could be explained by maternal GWG. Despite this, normal BMI women who gained less than the recommended GWG delivered more SGA babies, while in overweight/obese women we did not observe this association. Furthermore, the SGA rate was close to that of the LGA rate for the whole group, an unexpected finding. We could speculate that close surveillance of diet and weight gain could eventually be an explanation for both an increased rate of SGA in normal BMI women and a decreased rate of LGA in women with adequate or insufficient weight gain, while in women with excessive GWG, high rates of LGA remained. In non-diabetic pregnancies, delivery of SGA or low birth weight babies (< 2,500 g) is associated with multiple factors, such as hypertension, smoking and insufficient weight gain (27). No difference in hypertension or smoking rates across the weight gain groups was found. High rates of SGA were not expected, as it is well established that GDM treatment per se does not increase this risk (28). However, 22% of birth weight was ascribed to GWG in normal BMI women in our study, which could partially explain our findings. Weight gain below recommendations was not related to increased rates of SGA in other GDM cohorts (8,25) nor was it in a type 2 diabetes cohort (18); of note, the results were not adjusted by pre-pregnancy BMI categories. Weight loss in GDM women with BMI ≥ 25 kg/m 2 resulted in increased SGA in a large

This study reviewed the evidence that assessed the association between maternal pre-pregnan- cy body mass index (BMI) and/or gestational weight gain and offspring body composition in childhood. A systematic review was conducted. Cohort studies, case-control studies and ran- domized controlled trials measuring offspring body composition by indirect methods were in- cluded. Meta-analyses of the effect of pre-preg- nancy BMI on offspring fat-free mass, body fat percent, and fat mass were conducted through random-effects models. 20 studies were includ- ed, most of which reported a positive associa- tion of pre-pregnancy BMI with offspring body fat. Standardized mean differences in body fat percent, fat mass and fat-free mass between infants of women with normal pre-pregnancy BMI and those of overweight/obese women were 0.31 percent points (95%CI: 0.19; 0.42), 0.38kg (95%CI: 0.26; 0.50), and 0.18kg (95%CI: -0.07; 0.42), respectively. Evidence so far suggests that pre-pregnancy maternal overweight is associ- ated with higher offspring adiposity.

The Generalized Estimating Equations (GEE) with a Poisson distribution [46] was used to test differences in medication use across the eating disorder subtypes. In the first set of analyses we explored medication use “during pregnancy” and “postpartum” separately. In the second set, we assessed incident use of medications “during pregnancy only” and “postpartum only”. In the two sets of analyses we carried out the following steps: we first computed crude relative risks (RR) with 99% CI. Then, we entered in Model 1 the minimal sufficient adjustment set of variables (i.e., age, socioeconomic, status and educational level for all medication groups) for estimating the total association between eating disorders and the outcomes of interest. In a sen- sitivity analysis we included BMI at conception as additional covariate in Model 1 (because of the uncertainty in the direction of the association between BMI and eating disorders); however, the observed results did not differ substantially from the main analyses. In Model 2 we entered the set of confounders from Model 1 plus additional covariates (e.g., maternal depressive and anxiety symptoms, BMI, weight gain in pregnancy, alcohol use during early pregnancy and smoking until gestational week 30) in order to estimate the direct association between eating disorders and the outcomes of interest. Data are presented as crude and adjusted RR if there were at least three cases of women with eating disorders exposed to the specific medication groups.

Maternal distress might lead to parental neglect, which was earlier found related to childhood overweight [13–15]. In contrast to our findings, a just published cross-sectional study by Stenhammar et al. found that maternal stress reports were related to both childhood over- and underweight [25]. In that study, adjustment for maternal pre-pregnancy BMI and smoking was not carried out and follow-up was carried out at a different point in time during childhood, which complicates the comparison of the two studies. The cross-sectional study by Surkan et al. [26] found a relation between maternal depressive symptoms and childhood overweight at 6–24 months of age but also here our study differs. Firstly, the two studies used different subscales for measuring postpartum distress, and the study by Surkan et al. only measured depression. Secondly, they did not adjust for maternal pre- pregnancy BMI [2], gestational weight gain [7], and paternal BMI [2], which are established perinatal risk factors for childhood overweight. Finally, our study had a longer follow-up. We Table 1. Distribution of covariates for normal weight and

pose a risk to the mother and conceptus. Unfortunately, our study is based on the analysis of medical records and of data present in the death certificate, a fact that may lead to er- rors in the correct classification of the type of arterial hy- pertension. Aggravation of the clinical manifestations through association with preeclampsia (preeclampsia super- imposed upon chronic hypertension), which leads to con- vulsions, is observed in many chronic hypertensive women. One of the criteria used for the classification of groups is based on the presence of myocardial hypertrophy, which is generally absent in cases of pure preeclampsia, a fact that does not exclude the presence of mixed manifestations. Similarly, primigravidae with chronic hypertension with- out previous follow-up may present hypertensive peaks that lead the physician to the diagnosis of pure preeclampsia.

was based on plastic contrast. For example, to emphasize the central part among the other composition, the architect 'in the middle third of the main wall had arranged an extensive (5.60 m) but shallow (75 cm) niche‖ [16, 46p]. The building itself was small in scale, and to emphasize its monumentality and visually to expand its interior, the sculptors correlated the height of zofor (1.40 m) to 6-meter span of the building. Frieze made with account of the angle of perspective, was decorated with garlands, supported by frames of children. The images of the frieze were original in the "very understanding of the ideal of human beauty and its artistic expression in plastic forms" [44, 61p]. Often in these images there was observed a deliberate asymmetry (in the faces), the disproportion (in the figures), aimed to correct the visual angle. For the sculpture in Toprak-kala "a rhythmic repetition of similar sculptural groups, determining architectonic division of interior, was characteristic" [45]. The style and the manner of sculpture, for example, of friezes were the same as of acanthus, volutes. So, it can be assumed that the ancient sculptors have been actively involved not only in the development of sculptures, but in architectural and decorative compositions (especially of capitals), and the connection between the latters was very tight. In general, the nature of decoration of the premises depended on the functions of the latter: "household and service rooms were modestly furnished, as for residential and ceremonial rooms they were finished with the appropriate splendor‖ [46, 67p]. The sculpture, obeying the architecture, served as an element of its design. In Bactria a monumental sculpture "was designed primarily to be installed in the temples" [22, 901p]. In architectural

Methods: A prospective and retrospective, descriptive, ecological study was held at a teaching maternity in Recife, Brazil. Data from all 26.125 pregnant women admitted between 2000 and 2006 were analysed and 5.051 had the diagnosis of hypertensive disorder of pregnancy. The incidence percentages were calculated monthly per deliveries. Data on mean monthly temperature and relative humi- dity of the air were collected and monthly comparisons were conducted. February was chosen as the reference month due to its lowest incidence of the disease. The relative chance of hypertensive disorders of pregnancy for each other month was estimated by odds ratio and Pearson’s correlation coeficient was used to calcu- late the relation between the incidence of hypertensive disorders of pregnancy and the mean monthly temperature and relative air humidity.

Does the absence of a contribution of biological fac- tors to impaired cognitive outcome imply that biological factors do not play a role in developmental outcome of chil- dren in underprivileged societies? Presumably, that is not the correct conclusion. In the first place, da Rocha Neves et al. assessed only a few prenatal, perinatal, and neonatal factors. For instance, no data were available on mater- nal prepregnancy weight, maternal diseases, and maternal smoking during pregnancy, as well as perinatal asphyxia. These factors are known to have an adverse effect on long- term developmental outcome. 11,12 For example, term born

related behavioural, obstetrical and medical risk factors, based on mothers’ self-report before, during, and ater pregnancy (5). here are also other cases in some Western countries where maternal health related data are recorded and analysed systematically (6), whereas, reports made in developing countries are solely limited to cross-sectional studies, usually restricted to a single hospital or a certain city (7,8). In a study in Egypt on 750 pregnant women, 64% of the subjects were placed in the high-risk group (7). he amount of 55% out of the 330 studied pregnant women in a research in Niger sufered from at least one risk factor (8). To the best of our knowledge, no nationwide study has been conducted in Iran, in which pregnancy risk factors have been investigated comprehensively. he present study aims at depicting the risk factor proile in Iranian pregnant women before and during pregnancy.

Objective: To know the maternal mortality epidemiological profile due to pregnancy hypertensive disorders in Alagoas state, Brazil, from 2004 to 2013. Methods: This is an epidemiological, descriptive, documentary, cross- sectional study with a quantitative approach of a historical series from 2004 to 2013, in a Northeastern state of Brazil. Data were collected through the State Health Department of Alagoas’ database. Results: There was a greater number of maternal deaths in women aged between 20 and 39 years old by hypertensive syndromes in 2006, due to maternal hypertension with no specific cause. Conclusion: Pregnancy hypertensive disorders are considered pregnancy and childbirth complications, and a major cause of maternal and perinatal mortality, deserving special attention from health professionals, linked to maternal and child health.

Relative advantage is defined as the extent to which a person views an innovation as offering an advantage over previous ways of performing the same task (Roger, 1983; Agarwal & Prasad, 1997). Because Internet banking services allow customers to access their banking account from any location 24 hours a day and 7 days a week, it provides an enormous advantage and convenience to users (Tan & Teo, 2000). It also gives customers greater control over managing their finances, as they are able to check their accounts easily. Besides, a customer’s Internet experience, his or her banking needs can affect his adoption. As there are more financial products and services, it is expected that individuals with many financial accounts and who subscribe to many banking services will be more inclined to adopt Internet banking. Tan and Teo (2000) has reported that potential adopters of Internet banking services are likely to own multiple banking accounts and subscribe to various banking services. Rogers argues that potential adapters, who are allowed to experiment with an innovation will feel more comfortable with the innovation and are more likely to adopt it. Thus, if customers have the opportunity to try the innovation, certain fears of the unknown may be minimized. Government policy could also aid or hinder Internet diffusion (Mbarika, 2002). This is consistent with the national systems of innovation theory that posits that government policies may encourage or mandate technology development and adoption (King et. al., 1994; Wolcott et. al., 2001). Tan and Teo (2000) suggest that the greater the extent of government support for Internet commerce, the more likely Internet banking will be adopted, thus, confirming Goh’s (1995) suggestion that governments can play an interventionist and leading role in the diffusion of innovation. Potential users in turn would view new applications such as Internet banking services more favorably and hence be more like to use them. Thus, the second alternative hypothesis is:

Abstract: Queues are common sight of many banks in Ghana. The obvious implication of customers waiting in long and winding queues could result to prolonged discomfort and economic cost to them; however increasing the service rate will require additional number of tellers which implies extra cost to management. This study therefore attempts to find the trade-off between minimizing the total economic cost (waiting cost and service cost) and the provision of a satisfactory and reasonably shortest possible time of service to customers, in order to assist management of the bank in deciding the optimal number of tellers needed. Data for this study was collected at the Ghana Commercial Bank Ltd, Kumasi Main Branch for one month through observations, interviews and by administering of questionnaire and was formulated as multi-server single line queuing model. The data was analyzed using TORA optimization Software as well as using descriptive method of analysis. The performance measures of different queuing systems were evaluated and analyzed. The results of the analysis showed using a five teller system was better than a four or a six-teller system in terms of average waiting time and thetotal economic cost, hence the study recommends that, the management should adopt a five teller model to reduce total economic costs and increase customer satisfaction.

The transfer of the two main variable benefits of the program is conditioned on health and education requirements. Health conditions require children younger than 7 years old to have their growth monitored and vaccinations up-to-date and pregnant and nursing women to visit regularly health centers for prenatal and postnatal care. Education conditions are that all children aged 6 to 15 must be enrolled in school and attend at least 85% of school days. Enrollment in school is also required for youths aged 16 and 17 and the minimum attendance rate for them is 75 per cent. Variable benefits are paid until December of the year when the child becomes 15 years old or when the youth completes 17 years old. After its inception in 2007, when a child becomes 16 the family is entitled to receive the higher benefit of the BVJ.