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Importance Preterm birth is a leading cause of infant mortality, morbidity, and longterm disability, and these risks increase with decreasing gestational age. Obesity increases the risk of preterm delivery, but the associations between overweight and obesity and subtypes of preterm delivery are not clear. Objective To study the associations between early pregnancy body mass index (BMI) and risk of preterm delivery by gestational age and by precursors of preterm delivery. Design, Setting, and Participants Population-based cohort study of women with live singleton births in Sweden from 1992 through 2010. Maternal and pregnancy characteristics were obtained from the nationwide Swedish Medical Birth Register. Main Outcomes and Measures Risks of preterm deliveries (extremely, 22-27 weeks; very, 28-31 weeks; and moderately, 32-36 weeks). These outcomes were further characterized as spontaneous (related to preterm contractions or preterm premature rupture of membranes) and medically indicated preterm delivery (cesarean delivery before onset of labor or induced onset of labor). Risk estimates were adjusted for maternal age, parity, smoking, education, height, mother's country of birth, and year of delivery. Results Among 1 599 551 deliveries with information on early pregnancy BMI, 3082 were extremely preterm, 6893 were very preterm, and 67 059 were moderately preterm. Risks of extremely, very, and moderately preterm deliveries increased with BMI and the overweight and obesity-related risks were highest for extremely preterm delivery. Among normal-weight women (BMI 18.5-Ͻ25), the rate of extremely preterm delivery was 0.17%. As compared with normal-weight women, rates (%) and adjusted odds ratios (ORs [95% CIs]) of extremely preterm delivery were as follows: BMI 25 to less than 30 (0.21%; OR, 1.26; 95% CI, 1.15-1.37), BMI 30 to less than 35 (0.27%; OR, 1.58; 95% CI, 1.39-1.79), BMI 35 to less than 40 (0.35%; OR, 2.01; 95% CI, 1.66-2.45), and BMI of 40 or greater (0.52%; OR, 2.99; 95% CI, 2.28-3.92). Risk of spontaneous extremely preterm delivery increased with BMI among obese women (BMIՆ30). Risks of medically indicated preterm deliveries increased with BMI among overweight and obese women. Conclusions and Relevance In Sweden, maternal overweight and obesity during pregnancy were associated with increased risks of preterm delivery, especially extremely preterm delivery. These associations should be assessed in other populations.

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Pneumonia reportedly increases the risk of maternal and fetal illness and death, and in the United States is a significant cause of nonobstetrical maternal death. Maternal mortality has fallen dramatically since the advent of antibiotics. This prospective study enrolled 28 women who developed pneumonia while pregnant, and presented with signs and symptoms thereof, as well as an acute pulmonary infiltrate, to one of six hospitals in Edmonton, Alberta during a 2-year period in 2001-2003. The incidence was 1.1 per 1000 deliveries. A comparison group included 333 nonpregnant women 20 to 40 years of age who had pneumonia (incidence, 1.3 per 1000).The commonest symptoms of pneumonia in pregnant women were cough, fever, and shortness of breath. None of those affected had received influenza vaccine. Cough, fever, and sputum production dominated in nonpregnant women. Co-morbid conditions were conspicuously absent in the pregnant women. In contrast, the nonpregnant group included women with chronic obstructive lung disease, diabetes, heart disease, liver disease, cancer, and HIV infection. The gestational age when pneumonia developed averaged 29 weeks; more than half the patients were in the third trimester. In no pregnant woman was multilobar involvement observed, but four pregnant women had pleural effusion. Levels of hemoglobin, hematocrit, and albumin all were lower in pregnant women. All of the pregnant women had relatively low scores for severity of illness using the PORT (Pneumonia Patient Outcome Research Team) system. More than 95% of the comparison group also had low-risk PORT scores.Apart from an abortion at 10 weeks' gestation there were no fetal deaths. Live-born infants had a mean birth weight of 3320 gm and a mean 1-minute Apgar score of 8.6. None of the newborn infants had evident anomalies. The only woman who died was not pregnant. The 28 pregnant women received many different antibiotics, most commonly cefuroxime, azithromycin, and erythromycin. Pregnant women were twice as likely to be admitted to hospital than nonpregnant women in the same age group, but they had a shorter length of stay.These findings suggest that pregnant women tolerate pneumonia well and are unlikely to develop pulmonary or immunological complications. Pregnancy itself does not increase the risk of pneumonia. Neither the clinical findings nor the outcomes differ from those in nonpregnant women with pneumonia. EDITORIAL COMMENT(The abstracted study of Shariatzadeh is an important contribution to the literature. The data in it were collected prospectively and are populationrepresentative. The diagnosis of pneumonia was standard and straightforward, requiring both clinical symptoms and signs such as fever, cough, sputum production, shortness of breath, pleuritic chest pain, crackles, or evidence of consolidation by examination, and a confirmatory chest x-ray.This study suggests that pregnant women are no more vulnerable to pneumonia than nonpregnant women. The incidence of community acquired pneumonia among pregnant women was 1.1 per 10...

Vitamin A supplementation to preschool children is known to decrease the risks of mortality and morbidity from some forms of diarrhea, measles, human immunodeficiency virus (HIV) infection, and malaria. These effects are likely to be the result of the actions of vitamin A on immunity. Some of the immunomodulatory mechanisms of vitamin A have been described in clinical trials and can be correlated with clinical outcomes of supplementation. The effects on morbidity from measles are related to enhanced antibody production and lymphocyte proliferation. Benefits for severe diarrhea could be attributable to the functions of vitamin A in sustaining the integrity of mucosal epithelia in the gut, whereas positive effects among HIV-infected children could also be related to increased T-cell lymphopoiesis. There is no conclusive evidence for a direct effect of vitamin A supplementation on cytokine production or lymphocyte activation. Under certain circumstances, vitamin A supplementation to infants has the potential to improve the antibody response to some vaccines, including tetanus and diphtheria toxoids and measles. There is limited research on the effects of vitamin A supplementation to adults and the elderly on their immune function; currently available data provide no consistent evidence for beneficial effects. Additional studies with these age groups are needed

Although the diets of all low-income adults need major improvement, SNAP participants in particular had lower-quality diets than did income-eligible nonparticipants.

Maternal overweight and obesity are the most important preventable risk factors for adverse pregnancy outcomes worldwide. In this population-based cohort study, the Swedish Medical Birth Register was used to assess risks of spontaneous and medically indicated preterm deliveries among women with overweight and different grades of obesity, based on body mass index (BMI).The study included women with live singleton births in 1992 to 2010. Maternal and obstetric characteristics were obtained from the Birth Register, and BMI was calculated using the standard ranges for underweight, normal, overweight, and obesity grades 1 to 3. Gestational age was determined by ultrasound, date of last menstrual period, or postnatal assessment. Delivery was categorized as extremely, very, and moderately preterm (22Y27, 28Y31, and 32Y36 weeks, respectively). Preterm deliveries were characterized as spontaneous or medically indicated. Spontaneous preterm deliveries were stratified into preterm premature rupture of the membranes (PROM) or preterm labor. Logistic regression analysis was used to estimate the associations between BMI in early pregnancy and risks of preterm delivery. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Two-tailed P G 0.05 indicated statistical significance. All statistical analyses were performed with SAS software version 9.3.The final study population included 1,857,822 deliveries. Information about early pregnancy BMI was available in 86% (1,599,551) of deliveries. During the study period, 93,419 (5.03%) preterm deliveries were reported. Overall rates of extremely, very, and moderately preterm deliveries were 0.23%, 0.47%, and 4.36%, respectively. Preterm delivery rates increased with BMI among overweight and obese women and also among short women (G155 cm). Rates of overweight and obesity were substantially increased in women with hypertensive or diabetic conditions. Compared with women with normal BMIs, risks of extremely, very, and moderately preterm deliveries increased with BMI. The overweight and obesity-related risks were highest for extremely preterm delivery and lowest for moderately preterm delivery. Among normal-weight women, the rate of extremely preterm delivery was 0.17%. Compared with normal-weight women, rates and adjusted ORs (aORs) of extremely preterm delivery were 0.21% (aOR, 1.23; 95% CI, 1.13Y1.35), 0.27% (aOR, 1.53; 95% CI, 1.35Y1.74), 0.35% (aOR, 1.97; 95% CI, 1.62Y2.40), and 0.52% (aOR, 2.91; 95% CI, 2.21Y3.83) for BMIs of 25 to less than 30, 30 to less than 35, 35 to less than 40, and 40 or greater, respectively. Risks of spontaneous extremely preterm delivery increased with increasing obesity; however risks of spontaneous very or moderately preterm delivery were generally not associated with obesity. Women with grade 2 or 3 obesity had increased risks of extremely preterm delivery because of PROM and spontaneous labor. Risks of moderately preterm delivery due to PROM modestly increased with BMI, but no associations were found between BMI and risks of very or mod...

The aims of this study were to determine the sociodemographic and dietary correlates of household and child food insecurity in Bogotá, Colombia and to examine whether food insecurity is a risk factor for underweight or overweight in this population. We analyzed data from 2359 families with 2526 children 5-12 y of age who completed a cross-sectional survey conducted in 2006. The survey was representative of low- and middle-income families who had children enrolled in the public primary school system of Bogotá. We used a 16-item food insecurity scale, modified from the United States Household Food Security Survey Module, assessed children's dietary intake with a FFQ, and measured their height and weight. Mothers' anthropometry was obtained through self-report. We estimated adjusted prevalence ratios and 95% CI from binomial regression models. Household food insecurity with hunger and child food insecurity were each positively associated with maternal age, parity, and single parent status and inversely related to mean household income and number of home assets. Animal protein and snack food intake were inversely related to child food insecurity. In multivariate analyses, food-insecure children were 3 times more likely to be underweight than food-secure children (95% CI = 1.6, 5.4; P = 0.0007). Hunger in the household was significantly associated with maternal underweight. Food insecurity was not related to child stunting, child overweight, or maternal overweight. The prevalence of food insecurity in Bogotá is high and related to poverty. Food insecurity does not necessarily predict overweight in countries undergoing the nutrition transition.