Adverse birth outcomes in United Republic of Tanzania - impact and prevention of maternal risk factors

Abstract

Objective To determine risk factors for poor birth outcome and their population attributable fractions. Methods 1688 women who attended for antenatal care were recruited into a prospective study of the effectiveness of syphilis screening and treatment. All women were screened and treated for syphilis and other reproductive tract infections (RTIs) during pregnancy and followed to delivery to measure the incidence of stillbirth, intrauterine growth retardation (IUGR), low birth weight (LBW) and preterm live birth. Findings At delivery, 2.7% of 1536 women experienced a stillbirth, 12% of live births were preterm and 8% were LBW. Stillbirth was independently associated with a past history of stillbirth, short maternal stature and anaemia. LBW was associated with short maternal stature, ethnicity, occupation, gravidity and maternal malaria whereas preterm birth was associated with occupation, age of sexual debut, untreated bacterial vaginosis and maternal malaria. IUGR was associated with gravidity, maternal malaria, short stature, and delivering a female infant. In the women who had been screened and treated for syphilis, in between 20 and 34% of women with each outcome was estimated to be attributable to malaria, and 63% of stillbirths were estimated as being attributable to maternal anaemia. Screening and treatment of RTIs was effective and no association was seen between treated RTIs and adverse pregnancy outcomes. Conclusion Maternal malaria and anaemia continue to be significant causes of adverse pregnancy outcome in sub-Saharan Africa. Providing reproductive health services that include treatment of RTIs and prevention of malaria and maternal anaemia to reduce adverse birth outcomes remains a priority. Voir page 16 le résumé en français. En la página 16 figura un resumen en español.

Maternal Anemia in Benin: Prevalence, Risk Factors, and Association with Low Birth Weight

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“…In other sub Saharan countries the rates were lower, but not homogenous [2,12,19,21,26]. This maybe reflects behavioral and cultural diversity among pregnant adolescents across countries [27,28]. Higher proportions (LBW 38.9%, PTB 27.7%) were found in India [29].…”

Prevalence of Malaria and Sexually Transmitted and Reproductive Tract Infections in Pregnancy in Sub-Saharan Africa

“…Subanalysis in a prospective cohort study of pregnant women in Tanzania provided some of the only published data on coinfection: 48.3% of RPR-positive women also had placental parasitemia and 35.0% of RPR-negative women had malariainfected placentas (P Ͻ.001). 29 …”