Browsing by Author "Hofmeyr, G. Justus"
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- ItemAre women with history of pre-eclampsia starting a new pregnancy in good nutritional status in South Africa and Zimbabwe?(BioMed Central, 2018-06-15) Cormick, Gabriela; Betran, Ana Pilar; Harbron, Janetta; Dannemann Purnat, Tina; Parker, Catherine; Hall, David R.; Seuc, Armando H.; Roberts, James M.; Belizan, Jose M.; Hofmeyr, G. JustusBackground: Maternal nutritional status before and during pregnancy is an important contributor to pregnancy outcomes and early child health. The aim of this study was to describe the preconceptional nutritional status and dietary intake during pregnancy in high-risk women from South Africa and Zimbabwe. Methods: This is a prospective observational study, nested to the CAP trial. Anthropometric measurements before and during pregnancy and dietary intake using 24-h recall during pregnancy were assessed. The Intake Distribution Estimation software (PC-SIDE) was used to evaluate nutrient intake adequacy taking the Estimated Average Requirement (EAR) as a cut-off point. Results: Three hundred twelve women who had pre-eclampsia in their last pregnancy and delivered in hospitals from South Africa and Zimbabwe were assessed. 73.7 and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) whereas the prevalence of underweight was virtually non-existent. The majority of women had inadequate intakes of micronutrients. Considering food and beverage intake only, none of the micronutrients measured achieved the estimated average requirement. Around 60% of pregnant women reported taking folic acid or iron supplements in South Africa, but almost none did so in Zimbabwe. Conclusion: We found a high prevalence of overweight and obesity and high micronutrient intake inadequacy in pregnant women who had the previous pregnancy complicated with pre-eclampsia. The obesity figures and micronutrient inadequacy are issues of concern that need to be addressed. Pregnant women have regular contacts with the health system; these opportunities could be used to improve diet and nutrition.
- ItemInter-pregnancy interval and risk of recurrent pre-eclampsia : systematic review and meta-analysis(BioMed Central, 2016-07-18) Cormick, Gabriela; Betrán, Ana Pilar; Ciapponi, Agustín; Hall, David R.; Hofmeyr, G. JustusBackground: Women with a history of pre-eclampsia have a higher risk of developing pre-eclampsia in subsequent pregnancies. However, the role of the inter-pregnancy interval on this association is unclear. Objective: To explore the effect of inter-pregnancy interval on the risk of recurrent pre-eclampsia or eclampia. Search strategy: MEDLINE, EMBASE and LILACS were searched (inception to July 2015). Selection criteria: Cohort studies assessing the risk of recurrent pre-eclampsia in the immediate subsequent pregnancy according to different birth intervals. Data collection and analysis: Two reviewers independently performed screening, data extraction, methodological and quality assessment. Meta-analysis of adjusted odds ratios (aOR) with 95 % confidence intervals (CI) was used to measure the association between various interval lengths and recurrent pre-eclampsia or eclampsia. Main results: We identified 1769 articles and finally included four studies with a total of 77,561 women. The meta-analysis of two studies showed that compared to inter-pregnancy intervals of 2–4 years, the aOR for recurrent pre-eclampsia was 1. 01 [95 % CI 0.95 to 1.07, I2 0 %] with intervals of less than 2 years and 1.10 [95 % CI 1.02 to 1.19, I2 0 %] with intervals longer than 4 years. Conclusion: Compared to inter-pregnancy intervals of 2 to 4 years, shorter intervals are not associated with an increased risk of recurrent pre-eclampsia but longer intervals appear to increase the risk. The results of this review should be interpreted with caution as included studies are observational and thus subject to possible confounding factors.
- ItemPrepregnancy and early pregnancy calcium supplementation among women at high risk of pre-eclampsia : a multicentre, double-blind, randomised, placebo-controlled trial(Elsevier, 2019) Hofmeyr, G. Justus; Betran, Ana Pilar; Singata-Madliki, Mandisa; Cormick, Gabriela; Munjanja, Stephen P.; Fawcus, Susan; Mose, Simpiwe; Hall, David; Ciganda, Alvaro; Seuc, Armando H.; Lawrie, Theresa A.; Bergel, Eduardo; Roberts, James M.; Von Dadelszen, Peter; Belizan, Jose M.; Calcium and Pre-eclampsia Study GroupBackground: Reducing deaths from hypertensive disorders of pregnancy is a global priority. Low dietary calcium might account for the high prevalence of pre-eclampsia and eclampsia in low-income countries. Calcium supplementation in the second half of pregnancy is known to reduce the serious consequences of pre-eclampsia; however, the effect of calcium supplementation during placentation is not known. We aimed to test the hypothesis that calcium supplementation before and in early pregnancy (up to 20 weeks’ gestation) prevents the development of pre-eclampsia Methods: We did a multicountry, parallel arm, double-blind, randomised, placebo-controlled trial in South Africa, Zimbabwe, and Argentina. Participants with previous pre-eclampsia and eclampsia received 500 mg calcium or placebo daily from enrolment prepregnancy until 20 weeks’ gestation. Participants were parous women whose most recent pregnancy had been complicated by pre-eclampsia or eclampsia and who were intending to become pregnant. All participants received unblinded calcium 1·5 g daily after 20 weeks’ gestation. The allocation sequence (1:1 ratio) used computer-generated random numbers in balanced blocks of variable size. The primary outcome was pre-eclampsia, defined as gestational hypertension and proteinuria. The trial is registered with the Pan-African Clinical Trials Registry, number PACTR201105000267371. The trial closed on Oct 31, 2017. Findings: Between July 12, 2011, and Sept 8, 2016, we randomly allocated 1355 women to receive calcium or placebo; 331 of 678 participants in the calcium group versus 320 of 677 in the placebo group became pregnant, and 298 of 678 versus 283 of 677 had pregnancies beyond 20 weeks’ gestation. Pre-eclampsia occurred in 69 (23%) of 296 participants in the calcium group versus 82 (29%) of 283 participants in the placebo group with pregnancies beyond 20 weeks’ gestation (risk ratio [RR] 0·80, 95% CI 0·61–1·06; p=0·121). For participants with compliance of more than 80% from the last visit before pregnancy to 20 weeks’ gestation, the pre-eclampsia risk was 30 (21%) of 144 versus 47 (32%) of 149 (RR 0·66, CI 0·44–0·98; p=0·037). There were no serious adverse effects of calcium reported. Interpretation: Calcium supplementation that commenced before pregnancy until 20 weeks’ gestation, compared with placebo, did not show a significant reduction in recurrent pre-eclampsia. As the trial was powered to detect a large effect size, we cannot rule out a small to moderate effect of this intervention. ernal and Child Health.
- ItemShoulder dystocia : an update and review of new techniques(Health and Medical Publishing Group, 2009-10) Cluver, Catherine Anne; Hofmeyr, G. JustusENGLISH ABSTRACT: The definition for shoulder dystocia and the incidence varies. Worldwide, shoulder dystocia may be increasing23. In this update we look at the complications for both the mother and fetus. We review the risk factors and strategies for possible prevention. Management options include Mc Roberts position, techniques to deliver the anterior and posterior shoulder and finally salvage maneuvers. Salvage maneuvers which include Posterior Axillary Sling traction (PAST), the Zavanelli Maneuver and fracture of the clavicles. In cases of fetal death associated with an undelivered shoulder dystocia one can consider the transabdominal performance or facilitation of traditional vaginal maneuvers.