Perinatal and early life risk factors for inflammatory bowel disease

AIM:To investigate associations between perinatal risk factors and subsequent inflammatory bowel disease (IBD) in children and young adults.METHODS:Record linked abstracts of birth registrations,maternity,day case and inpatient admissions in a defined population of southern England.Investigation of 20 perinatal factors relating to the maternity or the birth:maternal age,Crohn's disease (CD) or ulcerative colitis (UC) in the mother,maternal social class,marital status,smoking in pregnancy,ABO blood group and rhesus status,pre-eclampsia,parity,the infant's presentation at birth,caesarean delivery,forceps delivery,sex,number of babies delivered,gestational age,birthweight,head circumference,breastfeeding and Apgar scores at one and five minutes.RESULTS:Maternity records were present for 180 children who subsequently developed IBD.Univariate analysis showed increased risks of CD among children of mothers with CD (P=0.011,based on two cases of CD in both mother and child) and children of mothers who smoked during pregnancy.Multivariate analysis confirmed increased risks of CD among children of mothers who smoked (odds ratio=2.04,95% CI=1.06-3.92) and for older mothers aged 35+ years (4.81,2.32-9.98).Multivariate analysis showed that there were no significant associations between CD and 17 other perinatal risk factors investigated.It also showed that,for UC,there were no significant associations with the perinatal factors studied.CONCLUSION:This study shows an association between CD in mother and child;and elevated risks of CD in children of older mothers and of mothers who smoked.

Factors of Neonatal Morbidity at the Provincial Hospital Center of Missour

Background: Although neonatal mortality decreases in different regions of the world, it is still a major problem in developing countries and particularly in Morocco. Purpose: The aims of this study are to examine the characteristics of pregnant women in the hospital center in the urban commune of Missour as well as the morphological data of the newborn and identify the risk factors implicated in neonatal morbidity. Materials and Methods: A retrospective study of collected data from records of women who gave birth in the Maternity of Missour during 2012. As well as a prospective study conducted at the maternity in 2013. Results: A total of 1108 women were included in this retrospective survey, of which 45% come from areas located far from the hospital center of the province and sometimes the access is tough in winter. Only 55.1% of pregnancy was followed. Among 1121 births, 49 babies (4.3%) showed a problematic birth situation: 31 (2.7%) newborns were hospitalized in pediatrics, of which 14 are premature. Neonatal mortality rate is 0.6% that is to say 7 early deaths. The risk factors associated to neonatal morbidity are gestational age and weight birth (in 50% of the cases, 85.7% of deaths are premature infants less than 1500 g). 14 (1.2%) were referred and 11 (0.9%) malformed were noticed. The prospective study states that among the 194 women analyzed, 89.7% are housewives. 89.1% have no medical coverage and 25.4% are illiterate. Only 29.2% benefit from a blood sample during pregnancy and 50% benefit from regular ultrasound follow-up. Conclusion: Mortality and neonatal morbidity constitute a public health priority in Morocco. Our work insists on the interest of an organized support of the newborn from the community to the different levels of the health pyramid.

Outcome and risk factors of early onset severe preeclampsia

Background Early onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, features, treatment, outcome and risk factors of early onset severe preeclampsia in Chinese women. Methods Four hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows： group A （less than 32 weeks, 73 cases）, group B ,（between 32 and 34 weeks, 71 cases）, and group C （greater than 34 weeks, 269 cases）. The demographic characteristics of the subjects, complications, delivery modes and outcome of pregnancy were analyzed retrospectively. Results The systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B, prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B. Liver and kidney dysfunction, pleural and peritoneal effusion, placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups. Twenty-four-hour urine protein levels at admission, intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia. Gestational week at admission and delivery week were also risk factors that affected perinatal outcome. Conclusions Early onset severe preeclampsia should be defined as occurring before 34 weeks, and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks. Independent risk factors should be used to tailor the optimized individual treatment plan, to balance both maternal and neonatal safety.