Interactions Among Urogenital, Intestinal, Skin, and Oral Infections in Pregnant and Lactating Panamanian Ngäbe Women: A Neglected Public Health Challenge

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

doi:10.4269/ajtmh.14-0547

Cited by 16 publications

(32 citation statements)

References 64 publications

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“…Based on government statistics, 6.7% of institutional deliveries are low birthweight infants at the country level (33), whereas low birthweight rates are as high as 14% in the Ngäbe population (34). We have previously reported that pregnant women in our study had a high prevalence (>50%) of several vaginal and intestinal infections as well as oral, skin and urinary tract infections (35). Despite distribution of iron and micronutrient supplements by the Ministry of Health, >40% of these women had deficiencies of vitamins A, D and B 12 , and CRP was elevated in 16.4% of these women (32).…”

Section: Study Populationmentioning

confidence: 55%

“…Women were considered for the study if consulting for normal pregnancy follow up, and they did not present with signs of distress. The presence of HIV and gestational diabetes had been ruled-out by the Ministry of Health (35).…”

Section: Study Populationmentioning

confidence: 99%

“…Maternal infections were evaluated both clinically and using laboratory tests as previously described (35). Briefly, skin lesions compatible with scabies and oral caries were detected during the clinical exam (0 = no, 1 = yes), and bacteriuria based on microscopic analysis of centrifuged urine was scored 0 (absent), 1+ (few), 2+ (moderate) and 3+ (abundant).…”

Section: Infectionsmentioning

confidence: 99%

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

Gonzalez‐Fernandez

Pons²,

Rueda

et al. 2020

Front. Public Health

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Conclusion: MINDI were bi-directionally associated with blood pressure indicators. In this MINDI cohort, infections, nutrients and cytokines both raised, and lowered BP indices. The presence of eMAP identified pregnant women at risk of hypertension whereas low PP was associated with lower SFH. Therefore, MAP and PP may help in detecting women at risk of adverse pregnancy outcomes in settings with limited access to technology.

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Section: Study Populationmentioning

confidence: 55%

Section: Study Populationmentioning

confidence: 99%

Section: Infectionsmentioning

confidence: 99%

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

Gonzalez‐Fernandez

Pons²,

Rueda

et al. 2020

Front. Public Health

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“…Our previous work in an indigenous population living in conditions of extreme poverty in Panama revealed not only a range of bacterial, fungal, protozoan, helminth, and ectoparasite infections among pregnant and lactating women but also synergistic and antagonistic interactions among the various pathogens [42]. Furthermore, informal conversations with physicians highlighted the challenge they faced in relying on CRP as a marker of inflammation under these conditions.…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

et al. 2017

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BackgroundThe usefulness of C-reactive protein (CRP) as a non-specific marker of inflammation during pregnancy and lactation is unclear in impoverished populations where co-existing infections and vitamin deficiencies are common.MethodsThis cross-sectional study in Panama recruited 120 pregnant and 99 lactating Ngäbe-Buglé women from 14 communities in rural Panama. Obstetric history, indoor wood smoke exposure, fieldwork, BMI, vitamins A, B12, D, and folic acid, and inflammation markers (CRP, neutrophil/lymphocyte ratio (NLR), plateletcrit and cytokines) were measured. Multiple regressions explored both associations of CRP with other inflammatory markers and associations of CRP and elevated CRP based on trimester-specific cut-offs with maternal factors, infections and vitamin deficiencies.ResultsCRP was higher in pregnancy (51.4 ± 4.7 nmol/L) than lactation (27.8 ± 3.5 nmol/L) and was elevated above trimester specific cut-offs in 21% of pregnant and 30% of lactating women. Vitamin deficiencies were common (vitamin A 29.6%; vitamin D 68.5%; vitamin B12 68%; folic acid 25.5%) and over 50% of women had two or more concurrent deficiencies as well as multiple infections. Multiple regression models highlighted differences in variables associated with CRP between pregnancy and lactation. In pregnancy, CRP was positively associated with greater indoor wood smoke exposure, caries and hookworm and negatively associated with Ascaris and vaginal Lactobacillus and Bacteroides/Gardnerella scores. Consistent with this, greater wood smoke exposure, caries as well as higher diplococcal infection score increased the odds of trimester-elevated CRP concentrations whereas longer gestational age lowered the likelihood of a trimester-elevated CRP. During lactation, folic acid deficiency was associated with higher CRP whereas parity, number of eosinophils and Mobiluncus score were associated with lower CRP. Also, a higher BMI and Trichomonas vaginalis score increased the likelihood of an elevated CRP whereas higher parity and number of eosinophils were associated with lower likelihood of an elevated CRP.ConclusionsInfections both raise and lower CRP concentrations in pregnant and lactating mothers. Only folic acid deficiency during lactation was associated with higher CRP concentrations. Caution is required when interpreting CRP concentrations in pregnant and lactating women who have co-existing nutrient deficiencies and multiple infections.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0307-1) contains supplementary material, which is available to authorized users.

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“…However, in humans, there is little evidence that pregnancy alters transmission risks for helminths,4,22 though a few results are suggestive of this possibility 23. Despite this, helminths and pregnancy might have synergistic effects on other health outcomes.…”

Section: Intersections Between Pregnancy and Helminth Infectionmentioning

confidence: 99%

Helminth infection during pregnancy: insights from evolutionary ecology

Blackwell

2016

IJWH

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Helminths are parasitic nematodes and trematodes, grouped together because of morphological similarities and commonalities in the effects infections have on hosts. These include complications such as anemia and biasing of immune responses, which can alter susceptibility for other diseases. For pregnant women, these complications might have implications for pregnancy outcomes or neonatal health. Here, I review studies of helminth infections during pregnancy, and ask the following questions: Do helminths affect maternal health or pregnancy outcomes? Are there consequences of maternal infection for infants? What are the effects of antihelminth treatment during pregnancy? The evidence suggests that the answers to these questions depend on the particular helminth species in question, maternal nutritional status, and the presence or absence of comorbid infection with other species, such as malaria. Moreover, there may also be unexpected consequences of treatment, as maternal infections can affect the priming of infant immune systems, with potential effects on infants later in life. These complex interactions suggest that a consideration of the evolutionary history of human–helminth interactions, as well as the ecological context of infections, can help to clarify an understanding of these host–parasite interactions and provide direction for future investigations.

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Interactions Among Urogenital, Intestinal, Skin, and Oral Infections in Pregnant and Lactating Panamanian Ngäbe Women: A Neglected Public Health Challenge

Cited by 16 publications

References 64 publications

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

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

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

Helminth infection during pregnancy: insights from evolutionary ecology

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