Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort

Gonzalez‐Fernandez, Doris; Pons, Emérita del Carmen; Rueda, Delfina; Sinisterra, Odalis; Murillo, Enrique G.; Scott, Marilyn; Koski, Kristine G.

doi:10.3389/fpubh.2020.00086

Cited by 9 publications

(16 citation statements)

References 94 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this population of pregnant mothers with low plasma volumes we found a consistent association of hepcidin with lower urinary pH, another indicator of volemic status ( 51 ), suggesting that hemoconcentration, previously reported in this population ( 25 ), may contribute to higher hepcidin concentrations.…”

Section: Discussionsupporting

confidence: 82%

“…Gray arrows with positive (+) and negative (–) signs indicate positive and negative associations, respectively. Associations of pulse pressure with TNF-α ( 25 ) and of CRP with wood smoke ( 24 ) had been reported previously. Black arrows with positive and negative signs inside black circles indicate factors that increased or decreased the odds of SFH between the 10th and the 90th centiles (SFH 10–90), between the 3rd and 10th centiles (SFH 30–10), and of <3rd centile using the INTERGROWTH-21 standards, and the odds of SFH <10th centile using the CLAP standards.…”

Section: Discussionmentioning

confidence: 53%

“…At the time of this study in 2010, maternal mortality rates in the Ngäbe-Buglé comarca were as high as 200 per 1000 live births ( 21 ) and the prevalence of low birth weight in the country was 8.8% ( 22 ) but suspected of being higher in the Ngäbe-Buglé indigenous community as 56% of mothers did not have professional delivery attendants ( 22 ). We had previously reported in pregnant Ngäbe-Buglé women a high prevalence of maternal infections ( 23 ), inflammation, and multiple nutrient deficiencies ( 24 ) and an association of low SFH with low maternal pulse pressure ( 25 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

INTERGROWTH-21 Identifies High Prevalence of Low Symphysis–Fundal Height in Indigenous Pregnant Women Experiencing Multiple Infections, Nutrient Deficiencies, and Inflammation: The Maternal Infections, Nutrient Deficiencies, and Inflammation (MINDI) Cohort

Gonzalez‐Fernandez

Nemeth

Pons³

et al. 2021

Current Developments in Nutrition

Self Cite

View full text Add to dashboard Cite

Background In absence of ultrasound, symphysis-fundal height (SFH) can assess maternal-fetal well-being as it is associated with gestational age, fetal weight and amniotic fluid volume. However, other modifiers of SFH, including maternal infections, nutrient deficiencies and inflammation (MINDI), have not been widely explored. Objectives Our objectives were two-fold: 1) to assess prevalence of low SFH in indigenous Panamanian women using both PAHO and INTERGROWTH-21 standards and 2) to explore associations of SFH with maternal health indicators: infections (oral, skin, urogenital, nematode infections), nutrient deficiencies [protein and iron indicators (ferritin, serum iron, serum transferrin receptor, hepcidin), folate, vitamins A, D, B12] and inflammation [leukocytes, C-reactive protein, cytokines]. Methods For this cross-sectional study, low-SFH-for-gestational-age was assessed using PAHO and INTERGROWTH < 10th centile in 174 women ≥16 weeks’ gestation. Bootstrapping selected MINDI variables for inclusion in multivariable fractional polynomial (MFP) logistic regressions for low-SFH. Associations of MINDI variables with hepcidin were also investigated. Results Prevalence of low-SFH was 8% using PAHO, but using INTERGROWTH, 50.6% had SFH < 10th centile, including 37.9% <3rd centile. Both PAHO-SFH < 10% and INTERGROWTH-SFH < 3rd centiles were associated with higher hepcidin (OR 1.12, p = 0.008 and OR = 3.04. p = 0.001, respectively) and with lower TNF-α (OR = 0.73, p = 0.012 and OR = 0.93, p = 0.015, respectively). Wood smoke exposure increased the odds of PAHO-SFH < 10th centile (OR = 1.19, p = 0.009) whereas higher BMI decreased the odds of INTERGROWTH-SFH < 3rd centile (OR = 0.87, p = 0.012). Lower pulse pressure (OR = 0.90, p = 0.009) and lower inflammatory responses [lower lymphocytes (OR = 0.21, p = 0.026), IL-17 (OR = 0.89, p = 0.011)] distinguished SFH < 3rd centile from SFH 3–10 using INTERGROWTH-21standards. The MFP regression for hepcidin controlling for SFH (Adj R2 = 0.40, p = 0.001) revealed associations with indicators of inflammation (CRP, p < 0.0001; IL-17, p = 0.012), acidic urinary pH (p = 0.008) and higher intake of supplements (p = 0.035). Conclusion Associations of low SFH with MINDI variables, including hepcidin, highlight its potential for early detection of multicausal in-utero growth faltering. LAY SUMMARY Symphysis-fundal height (SFH) is a measure of maternal-fetal well-being and is commonly used when sonography is not available to assess gestational age and the health of fetal-maternal unit. This simple non-invasive indicator uses a tape measure to measure the distance between the symphysis pubis and the highest point of the growing uterus. This distance was compared with two international standards: PAHO and INTERGROWTH. Using PAHO, 8% of women had low SFH (<10th centile for gestational age), but using INTERGROWTH standards, more than half of the women had low SFH with 37.5% having very low SFH (below the 3rd centile for gestational age). A SFH < 3rd centile was associated with higher hepcidin, a protein that decreases iron availability in blood as a defense against infections. In our study, low SFH was also associated with indicators of inflammation, malnutrition and a lower maternal blood pressure. This study supports the use of SFH in remote areas to identify pregnant women at risk of a poor pregnancy outcomes.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

INTERGROWTH-21 Identifies High Prevalence of Low Symphysis–Fundal Height in Indigenous Pregnant Women Experiencing Multiple Infections, Nutrient Deficiencies, and Inflammation: The Maternal Infections, Nutrient Deficiencies, and Inflammation (MINDI) Cohort

Gonzalez‐Fernandez

Nemeth

Pons³

et al. 2021

Current Developments in Nutrition

Self Cite

View full text Add to dashboard Cite

show abstract

“…Interestingly, the continuous variables for DBP and MAP, as well as iron supplementation were positively associated with SFH Z-score, but were not associated with sonography-estimated fetal weight or AFI. Supporting our findings, there is evidence that lower SFH Z-scores are associated with lower pulse pressure in a vulnerable indigenous population ( 53 ). Given the complexity of the SFH measurement, associations of blood pressure measurements with SFH warrant further investigation.…”

Section: Discussionsupporting

confidence: 87%

Associations of History of Displacement, Food Insecurity, and Stress With Maternal-Fetal Health in a Conflict Zone: A Case Study

Gonzalez‐Fernandez

Sahajpal

Chagüendo

et al. 2020

Front. Public Health

Self Cite

View full text Add to dashboard Cite

Background: In populations with a history of conflict, early identification of pregnant women who are at risk of adverse pregnancy outcomes is challenging, especially if sonography is not available. We evaluated the performance of symphysis-fundal height (SFH) for identification of high-risk pregnancies and investigated if food security and diet quality, clinical biomarkers, and stress were associated with SFH and two known indicators of maternal-fetal well-being, sonography-estimated fetal weight and amniotic fluid index (AFI). Methods: For this cross-sectional study, 61 women with high-risk pregnancies were recruited after referral to the obstetrics and gynecology unit at San José Hospital in Popayán, Colombia. Multiple stepwise linear and ordered logistic regressions were used to identify associations of SFH, sonography-estimated fetal weight and AFI classification with history of displacement, food insecurity, post-traumatic stress symptoms as well as biopsychosocial risk evaluated through the Colombian risk scale. Results: History of displacement was associated with lower SFH Z-scores, but higher hemoglobin, taking iron supplements and a higher diastolic blood pressure were associated with higher SFH Z-scores. SFH was also associated with AFI but not with sonography-estimated fetal weight. Stress indicators were associated with a higher AFI. In contrast family support, an element of the Colombian biopsychosocial risk assessment, was associated with a higher sonography-estimated fetal weight, whereas more hours of sleep/day were associated with lower sonography-estimated fetal weight. Conclusion: SFH was not only associated with biological factors known to affect maternal/fetal health but also with history of displacement, thus validating its use in conflict areas for pregnancy assessment. Associations of biopsychosocial stressors with maternal-fetal outcomes highlight the need for a systematic assessment of stress in pregnant women from conflict zones.

show abstract

“…We found that the diastolic blood pressure in the HCA group was significantly lower than that in the non-HCA group, and diastolic blood pressure was an independent protective factor in the complex model. Recent studies have suggested that infections related to anti-inflammatory reactions will lead to a reduction in diastolic blood pressure [ 35 ]. Compared to the babies born after idiopathic premature delivery or PROM, the babies born from hypertensive mothers have a lower risk of brain damage [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Application of a Prediction Model Based on the Laboratory Index Score in Prelabor Rupture of Membranes with Histologic Chorioamnionitis During Late Pregnancy

Jiang

et al. 2020

Med Sci Monit

View full text Add to dashboard Cite

Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort

Cited by 9 publications

References 94 publications

INTERGROWTH-21 Identifies High Prevalence of Low Symphysis–Fundal Height in Indigenous Pregnant Women Experiencing Multiple Infections, Nutrient Deficiencies, and Inflammation: The Maternal Infections, Nutrient Deficiencies, and Inflammation (MINDI) Cohort

INTERGROWTH-21 Identifies High Prevalence of Low Symphysis–Fundal Height in Indigenous Pregnant Women Experiencing Multiple Infections, Nutrient Deficiencies, and Inflammation: The Maternal Infections, Nutrient Deficiencies, and Inflammation (MINDI) Cohort

Associations of History of Displacement, Food Insecurity, and Stress With Maternal-Fetal Health in a Conflict Zone: A Case Study

Application of a Prediction Model Based on the Laboratory Index Score in Prelabor Rupture of Membranes with Histologic Chorioamnionitis During Late Pregnancy

Contact Info

Product

Resources

About