https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X%2814%2970227-X.pdf

Global causes of maternal death: a WHO systematic analysis

Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs. We present the latest CS rates and trends over the last 24 years. Methods We collected nationally-representative data on CS rates between 1990 to 2014 and calculated regional and subregional weighted averages. We conducted a longitudinal analysis calculating differences in CS rates as absolute change and as the average annual rate of increase (AARI). Results According to the latest data from 150 countries, currently 18.6% of all births occur by CS, ranging from 6% to 27.2% in the least and most developed regions, respectively. Latin America and the Caribbean region has the highest CS rates (40.5%), followed by Northern America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%) and Africa (7.3%). Based on the data from 121 countries, the trend analysis showed that between 1990 and 2014, the global average CS rate increased 12.4% (from 6.7% to 19.1%) with an average annual rate of increase of 4.4%. The largest absolute increases occurred in Latin America and the Caribbean (19.4%, from 22.8% to 42.2%), followed by Asia (15.1%, from 4.4% to 19.5%), Oceania (14.1%, from 18.5% to 32.6%), Europe (13.8%, from 11.2% to 25%), Northern America (10%, from 22.3% to 32.3%) and Africa (4.5%, from 2.9% to 7.4%). Asia and Northern America were the regions with the highest and lowest average annual rate of increase (6.4% and 1.6%, respectively). Conclusion The use of CS worldwide has increased to unprecedented levels although the gap between higher- and lower-resource settings remains. The information presented is essential to inform policy and global and regional strategies aimed at optimizing the use of CS.

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The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014.

High-quality health systems in the Sustainable Development Goals era: time for a revolution

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00838-7.pdf

Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group


 Introduction:
 Adverse pregnancy outcomes (APOs) have been linked with maternal mortality, higher risk of metabolic and cardiovascular diseases, and adverse neonatal outcomes. The World Health Organization recommends the adoption of a healthy lifestyle (maintaining a normal BMI, not smoking, regular exercise, healthy diet, avoiding harmful alcohol intake, and multivitamin supplementation) before conception to improve pregnancy health. However, the combined effect of these lifestyle factors on reducing APOs is unknown.
 
 
 Hypothesis:
 Adherence to healthy lifestyle prior to pregnancy may be associated with a lower risk of subsequent development of APOs.
 
 
 Methods:
 We followed 15,509 women without chronic diseases (27,135 pregnancies) and participating in an ongoing cohort in the United States, the Nurses’ Health Study II. Healthy lifestyle factors preceding pregnancy were prospectively assessed every 2 to 4 years from 1991 to 2009, using validated measures. Reproductive history was self-reported in 2001 and 2009. A composite outcome of APOs included miscarriage, ectopic pregnancy, gestational diabetes, gestational hypertension, preeclampsia, preterm birth, stillbirth, and low birth weight (<5.5 lbs). We estimated the relative risks (RRs) of APOs according to the number of healthy lifestyle factors (0-6), using Poisson regression models with generalized estimating equations, specifying an exchangeable correlation structure, adjusting for maternal age, race/ethnicity, year of birth, history of infertility, parity, and interpregnancy interval.
 
 
 Results:
 The mean (SD) maternal age was 35.1 (4.2) years. Nearly one in three pregnancies (N=9,702, 35.8%) were complicated with an APO. All healthy lifestyle factors, except alcohol consumption, were independently associated with APOs after mutual adjustment for each other. The combination of 6 low-risk factors (BMI=18.5-24.9 kg/m
 2
 , non-smoking, ≥150 minutes/week of moderate to vigorous physical activity, healthy eating (top 40% of Dietary Approaches to Stop Hypertension score), low-to-moderate alcohol intake (<15 g/day), and use of multivitamin) was inversely associated with risk of APOs, in a dose-dependent manner (
 P
 trend<0.001). Compared to women who had 0 or 1 healthy lifestyle factors, those with 6 had a 45% lower risk of APOs (RR=0.55, 95% CI=0.44-0.68). The associations were stronger among women who were <35 years or had BMI <25 kg/m
 2
 but did not differ by parity. If the relationships were causal, 10% of APOs in the study population could have been prevented by the adoption of all 6 healthy lifestyle factors (population attributable risk=10%, 95% CI=6%-14%).
 
 
 Conclusions:
 Our findings suggest that pre-conception healthy lifestyle is associated with a substantially lower risk of APOs and could be an effective intervention for the prevention of APOs and their downstream long-term maternal and offspring health consequences.


Abstract 15: Pre-Pregnancy Healthy Lifestyle is Associated With Lower Risk of Adverse Pregnancy Outcomes: A Prospective Cohort Study

Prevalence of cervical human papillomavirus in Mexico, 2010–2017: analysis of 2.7 million women

The Neglected Problem of Obesity during Pregnancy in Mexico: Secondary Data Analysis of the 2018 National Survey of Health and Nutrition

Background: The alteration in the composition of the gut microbiota has been associated with an increased risk of developing cardiovascular and metabolic diseases. The present study evaluated the association between the relative abundance (RA) of intestinal Staphylococcus aureus and the inflammatory response with cardiometabolic alterations in children. Methods: This cross-sectional study included 1142 children (age 6-12 years), which were classified by degree of adiposity. Anthropometry, cardiometabolic markers, and RA of intestinal S. aureus were measured. Cytokine concentrations were available in 626 children. Path coefficients (PC) were estimated by path analysis. Results: RA of S. aureus was positively associated with cholesterol PC = 24.98 (95% CI 10.76 to 39.21) and negatively with triglycerides PC = -13.10 (95% CI -22.73 to -3.48). Body mass index (BMI) Z-scores had significant mediation effects on the association between RA of S. aureus with waist circumference PC = 2.87 (95% CI 0.58 to 5.16), triglycerides PC = 6.63 (95% CI 1.29 to 11.98), low-density lipoproteins (LDL) PC = 1.73 (95% CI 0.27 to 3.18), and high-density lipoproteins PC = -1.20 (95% CI -2.19 to -0.22). Interleukin 6 (IL-6) was negatively associated with glucose PC = -3.01 (95% CI -5.85 to -0.17) and LDL PC = -8.65 (95% CI -16.54 to -0.77), and interleukin 10 (IL-10) was positively associated with glucose PC = 3.37 (95% CI 0.47 to 6.26). Conclusions: It is suggested that the RA of S. aureus, IL-6, and IL-10 are associated with cardiometabolic alterations in children, where BMI Z-scores have an important mediating effect for the development of these.

Eduardo Ortiz-Panozo

Papers

Abstract 15: Pre-Pregnancy Healthy Lifestyle is Associated With Lower Risk of Adverse Pregnancy Outcomes: A Prospective Cohort Study

Prevalence of cervical human papillomavirus in Mexico, 2010–2017: analysis of 2.7 million women

The Neglected Problem of Obesity during Pregnancy in Mexico: Secondary Data Analysis of the 2018 National Survey of Health and Nutrition

High Relative Abundance of Staphylococcus aureus and Serum Cytokines Are Associated with Cardiometabolic Abnormalities in Children.