Which Anthropometric Indicators Identify a Pregnant Woman as Acutely Malnourished and Predict Adverse Birth Outcomes in the Humanitarian Context?

Ververs, Mija; Antierens, Annick; Sackl, Anita; Staderini, Nelly; Captier, Valérie

doi:10.1371/currents.dis.54a8b618c1bc031ea140e3f2934599c8

Cited by 167 publications

(164 citation statements)

References 30 publications

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“…Protein-energy undernutrition was defined as low body mass index (BMI < 18.5 kg/m 2 ) or low MUAC (<22 cm) at enrolment, and short stature as height <150 cm [38]. Moderate-to-severe anaemia was defined as Hb <90 g/L at enrolment, and inflammation as a hs-CRP level ≥5 mg/L.…”

Section: Methodsmentioning

confidence: 99%

Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

Ome-Kaius

Karl

Wangnapi

et al. 2017

Malar J

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BackgroundDoppler velocimetry studies of umbilical artery (UA) and middle cerebral artery (MCA) flow help to determine the presence and severity of fetal growth restriction. Increased UA resistance and reduced MCA pulsatility may indicate increased placental resistance and intrafetal blood flow redistribution. Malaria causes low birth weight and fetal growth restriction, but few studies have assessed its effects on uteroplacental and fetoplacental blood flow.MethodsColour-pulsed Doppler ultrasound was used to assess UA and MCA flow in 396 Papua New Guinean singleton fetuses. Abnormal flow was defined as an UA resistance index above the 90th centile, and/or a MCA pulsatility index and cerebroplacental ratio (ratio of MCA and UA pulsatility index) below the 10th centile of population-specific models fitted to the data. Associations between malaria (peripheral infection prior to and at ultrasound examination, and any gestational infection, i.e., ‘exposure’) and abnormal flow, and between abnormal flow and birth outcomes, were estimated.ResultsOf 78 malaria infection episodes detected before or at the ultrasound visit, 62 (79.5%) were Plasmodium falciparum (34 sub-microscopic infections), and 16 were Plasmodium vivax. Plasmodium falciparum infection before or at Doppler measurement was associated with increased UA resistance (adjusted odds ratio (aOR) 2.3 95% CI 1.0–5.2, P = 0.047). When assessed by ‘exposure’, P. falciparum infection was significantly associated with increased UA resistance (all infections: 2.4, 1.1–4.9, P = 0.024; sub-microscopic infections 2.6, 1.0–6.6, P = 0.051) and a reduced MCA pulsatility index (all infections: 2.6, 1.2–5.3, P = 0.012; sub-microscopic infections: 2.8, 1.1–7.5, P = 0.035). Sub-microscopic P. falciparum infections were additionally associated with a reduced cerebroplacental ratio (3.64, 1.22–10.88, P = 0.021). There were too few P. vivax infections to draw robust conclusions. An increased UA resistance index was associated with histological evidence of placental malaria (5.1, 2.3–10.9, P < 0.001; sensitivity 0.26, specificity 0.93). A low cerebroplacental Doppler ratio was associated with concurrently measuring small-for-gestational-age, and with low birth weight.Discussion/conclusionBoth microscopic and sub-microscopic P. falciparum infections impair fetoplacental and intrafetal flow, at least temporarily. Increased UA resistance has high specificity but low sensitivity for the detection of placental infection. These findings suggest that interventions to protect the fetus should clear and prevent both microscopic and sub-microscopic malarial infections. Trial Registration ClinicalTrials.gov NCT01136850. Registered 06 April 2010Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1689-z) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

Ome-Kaius

Karl

Wangnapi

et al. 2017

Malar J

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“…The average of three MUAC measurements was calculated and then categorized as normal or low MUAC. A MUAC measurement less than 23 cm was classified as low MUAC [22]. The variable for antenatal care visits was coded as a binary variable for whether they have sought antenatal care (ANC).…”

Section: Data Calculations and Variable Definitionsmentioning

confidence: 99%

Predictors of anemia in pregnant women residing in rural areas of the Oromiya region of Ethiopia

et al. 2017

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Background: Anemia in pregnancy is associated with higher risk of low birth weight and both maternal and perinatal mortality. While previous studies in Ethiopia have examined factors associated with anemia, which factors are the most important determinants of anemia in this population remain unclear. The objective of this study was to examine the association between anemia status in pregnant women with different health, behavioral, and socioeconomic factors in Oromiya province of Ethiopia. Methods: This study used pregnancy enrollment data from a longitudinal birth cohort study conducted in Ethiopia. Survey data on maternal and household characteristics were collected at enrollment and maternal hemoglobin levels were measured. The analysis includes 4600 pregnant women. Logistic regression models were used to identify factors associated with maternal anemia in pregnancy. Results: Controlling for geographic location and religion, low maternal MUAC and previous pregnancies were associated with increased odds of anemia, with odds ratios of 1.30 (p < 0.001, CI 1.12-1.51), and 1.50 (p = 0. 002, CI 1.16-1.95), respectively. For each additional point on the handwashing score scale, the odds of being anemic were reduced by 12% (p < 0.001, CI 0.82-0.94). Numerate women compared to non-numerate women had 30% lower odds (p < 0.001, CI 0.57-0.85). Conclusion: Controlling for woreda and religion, low maternal MUAC, and previous pregnancy increased odds of anemia while numeracy and better handwashing practices significantly reduced the odds of anemia in pregnancy. Further investigation is needed to determine the cause of anemia in pregnant women in Oromiya and to determine the effects of maternal anemia on birth outcomes.

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“…Mother's mid-upper arm circumstance was recoded into two categories "0-23", "24-99". Although no standard cut-off has been established for using MUCA in adults, a cut-off of less than 23 cm is often recommended to indicate women's acute malnutrition [16]. Using the WHO syntax, children were categorized as stunted, wasted, underweight and BMI-for-age based on their Z-scores for weight for height (WHZ), height-for-age (WAZ), and body-mass-index-for age (BMIZ), respectively [17].…”

Section: Methodsmentioning

confidence: 99%

Water Access, Women’s Empowerment, Sanitation and Children’s Anthropometric Status: A Study of Ethiopian Mothers With Children Under Five

Ahmadi¹,

Sinclair²,

Melgar‐Quiñonez³

et al. 2017

WIT Transactions on Ecology and the Environment

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Recent studies have shown that most African countries are overwhelmed with problems related to water access. Women are disproportionality responsible for fetching water for drinking and domestic use. Notably, fetching water has been shown to influence various aspects of women's lives. The main objective of this paper is to study the association between the amount of time mothers spend carrying water and factors such as socioeconomic characteristics, women's empowerment (i.e., decision making, group membership, attitudes toward gender equality), income-generating activities (i.e., access to land and saving money (as proxies)), maternal nutritional status (i.e., Mid Upper Arm Circumstances (MUAC), dietary diversity score), childcare practices (i.e., breastfeeding, taking children for weighting or treatment for malnutrition, and children's dietary diversity), and children's anthropometric indicators. Data from a survey carried out in Ethiopia in 2016 was used in this article. Different statistical analyses formed the basis of the work. Firstly, descriptive statistics were used to analyse the data. Secondly, bivariate analyses were used to examine the association between exposure and outcome variables. Finally, binary logistic regression analyses were conducted. Results showed significant negative associations between the time spent fetching and saving money, group membership, attitudes toward gender equality, MUAC, dietary diversity, childcare care practices, and children's anthropometric indicators. This paper supports the important link between water access and women and children's nutritional statuses.

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Which Anthropometric Indicators Identify a Pregnant Woman as Acutely Malnourished and Predict Adverse Birth Outcomes in the Humanitarian Context?

Cited by 167 publications

References 30 publications

Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

Predictors of anemia in pregnant women residing in rural areas of the Oromiya region of Ethiopia

Water Access, Women’s Empowerment, Sanitation and Children’s Anthropometric Status: A Study of Ethiopian Mothers With Children Under Five

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