BMJ. 2013 Jun 21;346:f3443. doi: 10.1136/bmj.f3443.
Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW; Nutrition Impact
Model Study Group (anaemia).
Comment in
BMJ. 2013;347:f4399.
OBJECTIVES: To summarise evidence on the associations of maternal anaemia and
prenatal iron use with maternal haematological and adverse pregnancy outcomes;
and to evaluate potential exposure-response relations of dose of iron, duration
of use, and haemoglobin concentration in prenatal period with pregnancy outcomes.
DESIGN: Systematic review and meta-analysis
DATA SOURCES: Searches of PubMed and Embase for studies published up to May 2012
and references of review articles.
STUDY SELECTION CRITERIA: Randomised trials of prenatal iron use and prospective
cohort studies of prenatal anaemia; cross sectional and case-control studies were
excluded.
RESULTS: 48 randomised trials (17 793 women) and 44 cohort studies (1 851 682
women) were included. Iron use increased maternal mean haemoglobin concentration
by 4.59 (95% confidence interval 3.72 to 5.46) g/L compared with controls and
significantly reduced the risk of anaemia (relative risk 0.50, 0.42 to 0.59),
iron deficiency (0.59, 0.46 to 0.79), iron deficiency anaemia (0.40, 0.26 to
0.60), and low birth weight (0.81, 0.71 to 0.93). The effect of iron on preterm
birth was not significant (relative risk 0.84, 0.68 to 1.03). Analysis of cohort
studies showed a significantly higher risk of low birth weight (adjusted odds
ratio 1.29, 1.09 to 1.53) and preterm birth (1.21, 1.13 to 1.30) with anaemia in
the first or second trimester. Exposure-response analysis indicated that for
every 10 mg increase in iron dose/day, up to 66 mg/day, the relative risk of
maternal anaemia was 0.88 (0.84 to 0.92) (P for linear trend<0.001). Birth weight
increased by 15.1 (6.0 to 24.2) g (P for linear trend=0.005) and risk of low
birth weight decreased by 3% (relative risk 0.97, 0.95 to 0.98) for every 10 mg
increase in dose/day (P for linear trend<0.001). Duration of use was not
significantly associated with the outcomes after adjustment for dose.
Furthermore, for each 1 g/L increase in mean haemoglobin, birth weight increased
by 14.0 (6.8 to 21.8) g (P for linear trend=0.002); however, mean haemoglobin was
not associated with the risk of low birth weight and preterm birth. No evidence
of a significant effect on duration of gestation, small for gestational age
births, and birth length was noted.
CONCLUSIONS: Daily prenatal use of iron substantially improved birth weight in a
linear dose-response fashion, probably leading to a reduction in risk of low
birth weight. An improvement in prenatal mean haemoglobin concentration linearly
increased birth weight.
PMCID: PMC3689887
PMID: 23794316 [PubMed - indexed for MEDLINE]
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8.9.13
Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis.
6.8.13
Schedules for home visits in the early postpartum period.
Yonemoto N, Dowswell T, Nagai S, et al. Schedules for home visits in the early postpartum period. Cochrane Database Syst Rev. 2013 Jul 23;7:CD009326. (Review) PMID: 23881661
BACKGROUND: Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families.
OBJECTIVES: To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. SEARCH
METHODS: We searched the Cochrane Pregnancy and Childbirth Group`s Trials Register (28 January 2013) and reference lists of retrieved articles.
SELECTION CRITERIA: Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems).
DATA COLLECTION AND ANALYSIS: Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software.
MAIN RESULTS: We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no strong evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care.
AUTHORS' CONCLUSIONS: Overall, findings were inconsistent. Postnatal home visits may promote infant health and maternal satisfaction. However, the frequency, timing, duration and intensity of such postnatal care visits should be based upon local needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.
BACKGROUND: Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families.
OBJECTIVES: To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. SEARCH
METHODS: We searched the Cochrane Pregnancy and Childbirth Group`s Trials Register (28 January 2013) and reference lists of retrieved articles.
SELECTION CRITERIA: Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems).
DATA COLLECTION AND ANALYSIS: Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software.
MAIN RESULTS: We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no strong evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care.
AUTHORS' CONCLUSIONS: Overall, findings were inconsistent. Postnatal home visits may promote infant health and maternal satisfaction. However, the frequency, timing, duration and intensity of such postnatal care visits should be based upon local needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.
31.7.11
Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum Reaffirmation Recommendation Statement
The U.S. Preventive Services Task Force (USPSTF) has reaffirmed its 2005 recommendation that all newborns should receive topical eye medication for the prevention of gonococcal ophthalmia neonatorum within 24 hours of birth. This is a Grade A recommendation. The USPSTF concluded that there was no evidence of harms associated with the treatment, and the evidence showed a clear benefit to offering the preventive measure to all newborns. The recommendation is available at http://www.uspreventiveservicestaskforce.org/uspstf10/gonoculproph/gonocuprs.htm.
28.10.09
Heel-Lancing in Newborns: Behavioral and Spectral Analysis Assessment of Pain Control Methods.
Weissman, A., Aranovitch, M., Blazer, S., Zimmer, E. Z.
PEDIATRICS. Vol. 124 No. 5 November 2009, pp. e921-e926 doi:10.1542/peds.2009-0598
OBJECTIVE: Pain experience can alter clinical outcome, brain development, and subsequent behavior in newborns, primarily in preterm infants. The aims of this study were (1) to evaluate several simple, commonly used methods for pain control in newborns and (2) to evaluate the concordance between behavioral and autonomic cardiac reactivity to pain in term neonates during heel-lancing.
METHODS: A prospective study was conducted of 180 term newborn infants who were undergoing heel-lancing for routine neonatal screening of phenylketonuria and hypothyroidism. Newborns were assigned to 6 groups: (1) control (no pain relief intervention); (2) nonnutritive sucking; (3) holding by mother; (4) oral glucose solution; (5) oral formula feeding; or (6) breastfeeding. Outcome measures included the Neonatal Facial Coding System score; cry duration; and autonomic variables obtained from spectral analysis of heart rate variability before, during, and after heel-lancing.
RESULTS: Infants with no pain control showed the highest pain manifestation compared with newborns to whom pain control was provided. Infants who breastfed or received an oral formula showed the lowest increase in heart rate (21 and 23 beats per minute, respectively, vs 36; P < .01), lowest neonatal facial score (2.3 and 2.9, respectively, vs 7.1; P < .001), lowest cry duration (5 and 13 seconds, respectively, vs 49; P < .001), and lowest decrease in parasympathetic tone (–2 and –2.4, respectively, vs 1.2; P < .02) compared with the other groups.
CONCLUSIONS: Any method of pain control is better than none. Feeding and breastfeeding during heel-lancing were found to be the most effective methods of pain relief.
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